Healthcare Provider Details

I. General information

NPI: 1508966490
Provider Name (Legal Business Name): KYI WIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. WINSTON KW CHAO

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 MASON ST
SAN FRANCISCO CA
94130
US

IV. Provider business mailing address

78 JUSTIN CIRCLE
ALAMEDA CA
94502
US

V. Phone/Fax

Practice location:
  • Phone: 415-364-7600
  • Fax: 415-986-1130
Mailing address:
  • Phone: 510-769-0487
  • Fax: 510-769-0487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA51322
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: