MEDICARE: DR. MYAT HTUT DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	LL-346-13	NV
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DDS100235	CA

General Provider Information

NPI Number	:	1073949541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MYAT HTUT DDS

Provider Business Mailing Address
First Line	:	20709 GOLDEN SPRINGS DR STE 202
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-3847
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	20709 GOLDEN SPRINGS DR STE 202
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-3847
Country	:	US
Telephone Number	:	909-594-0518
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	05/10/2020

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