MEDICARE: MIN LWIN 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	1223G0001X	General Practice Dentistry	39985	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	G9169202	OTHER	CA	DENTI-CAL

General Provider Information

NPI Number	:	1215327135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIN LWIN DDS

Provider Business Mailing Address
First Line	:	8038 GARVEY AVE STE B
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-2483
Country	:	US
Telephone Number	:	626-571-7000
Fax Number	:	626-571-8454

Provider Business Practice Location Address
First Line	:	8038 GARVEY AVE STE B
Second Line	:
City	:	ROSEMEAD
State	:	CA
Zip	:	91770-2483
Country	:	US
Telephone Number	:	626-571-7000
Fax Number	:	626-571-8454

Authorized Official
Title or Position	:	OWNER
Name	:	MIN LWIN
Credential	:
Telephone Number	:	626-571-7000

Provider Enumeration Date	:	01/30/2015
Last Update Date	:	01/30/2015

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