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General NPI Number Information
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NPI Number | 1699945642
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Entity Type | Organization
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Legal Business Name | SAN SAN WYNN, M.D., P.C.
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 07/12/2008
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Provider Practice Location Address
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Address Line | 723 E 87TH ST
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City | BROOKLYN
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State | NY
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Zip | 11236-3620
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Country | US
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Telephone | 718-498-5754
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Fax |
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Provider Business Mailing Address
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Address Line | 56 HAMILTON DR
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City | ROSLYN
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State | NY
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Zip | 11576-3129
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAN SAN WYNN
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Credential | M.D.
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Telephone | 718-498-5754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 220806
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License Number State | NY
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