Healthcare Provider Details

I. General information

NPI: 1184872194
Provider Name (Legal Business Name): MIDWEST CITY KIDNEY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S DOUGLAS BLVD SUITE K
MIDWEST CITY OK
73130-5239
US

IV. Provider business mailing address

1201 S DOUGLAS BLVD SUITE K
MIDWEST CITY OK
73130-5239
US

V. Phone/Fax

Practice location:
  • Phone: 405-737-4900
  • Fax: 405-737-3606
Mailing address:
  • Phone: 405-737-4900
  • Fax: 405-737-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAUNG MAUNG KYI
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 405-737-4900