Healthcare Provider Details

I. General information

NPI: 1316808827
Provider Name (Legal Business Name): WINPB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 DICKENS PL
WEST PALM BEACH FL
33411-1864
US

IV. Provider business mailing address

930 DICKENS PL
WEST PALM BEACH FL
33411-1864
US

V. Phone/Fax

Practice location:
  • Phone: 561-484-4136
  • Fax: 214-617-0486
Mailing address:
  • Phone: 561-484-4136
  • Fax: 214-617-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: WIN SI THU
Title or Position: OWNER
Credential: MD
Phone: 561-484-4136