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General NPI Number Information
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NPI Number | 1588246375
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Entity Type | Individual
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Provider Name | KYAWZAY LATT MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2021
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 417 TRENTON AVE
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City | UTICA
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State | NY
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Zip | 13502-1613
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Country | US
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Telephone | 315-797-5810
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Fax | 315-732-7030
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Provider Business Mailing Address
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Address Line | 111 HOSPITAL DR
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City | UTICA
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State | NY
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Zip | 13502-2517
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Country | US
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Telephone | 315-917-9966
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Fax | 315-801-8391
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 332850
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License Number State | NY
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