Healthcare Provider Details

I. General information

NPI: 1316587793
Provider Name (Legal Business Name): MYAT MIN HTUT, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 05/10/2020
Certification Date: 05/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20709 GOLDEN SPRINGS DR STE 202
WALNUT CA
91789-3847
US

IV. Provider business mailing address

20709 GOLDEN SPRINGS DR STE 202
WALNUT CA
91789-3847
US

V. Phone/Fax

Practice location:
  • Phone: 909-594-0518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MYAT HTUT
Title or Position: CEO
Credential:
Phone: 626-466-5492