Healthcare Provider Details

I. General information

NPI: 1457734642
Provider Name (Legal Business Name): SAN KYAW KHINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 MADISON AVE RM 1628
NEW YORK NY
10017-5457
US

IV. Provider business mailing address

315 MADISON AVE RM 1628
NEW YORK NY
10017-5457
US

V. Phone/Fax

Practice location:
  • Phone: 929-551-3588
  • Fax:
Mailing address:
  • Phone: 929-551-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA10909800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD28801
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: