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General NPI Number Information
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NPI Number | 1760852966
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Entity Type | Organization
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Legal Business Name | WIN FAMILY MEDICINE INC
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Dates
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Enumeration Date | 09/30/2015
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 811 E 11TH ST STE 205
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City | UPLAND
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State | CA
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Zip | 91786-4872
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Country | US
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Telephone | 909-931-5106
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Fax | 909-931-5029
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Provider Business Mailing Address
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Address Line | 811 E 11TH ST STE 205
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City | UPLAND
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State | CA
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Zip | 91786-4872
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Country | US
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Telephone | 909-931-5106
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Fax | 909-931-5029
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANDAR WIN
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Credential | MD
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Telephone | 909-931-5106
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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 | A100405
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License Number State | CA
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