Healthcare Provider Details

I. General information

NPI: 1689428500
Provider Name (Legal Business Name): AYE T KYAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 INDUSTRIAL PARK RD
ESPANOLA NM
87532-3600
US

IV. Provider business mailing address

MDEC/ECFH PO BOX 158 538 PASEO DE ONATE
ESPANOLA NM
87532
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-7218
  • Fax: 505-753-5815
Mailing address:
  • Phone: 505-753-7218
  • Fax: 505-753-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2024-0048
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: