=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942842356
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KYAW & TAN DENTAL PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2019
-----------------------------------------------------
Last Update Date | 10/17/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4260 MAIN ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-4709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-461-4678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4260 MAIN ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11355-4709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. YIN YIN TAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 646-932-9693
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------