MEDICARE: DR. SAN SAN WAI M.D.,FACP,MBBS

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	207R00000X	Internal Medicine Physician	A56447	CA

General Provider Information

NPI Number	:	1245234996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAN SAN WAI M.D.,FACP,MBBS

Provider Business Mailing Address
First Line	:	2211 W MAGNOLIA BLVD
Second Line	:	STE 230
City	:	BURBANK
State	:	CA
Zip	:	91506-1762
Country	:	US
Telephone Number	:	818-391-1028
Fax Number	:	818-391-1037

Provider Business Practice Location Address
First Line	:	2211 W MAGNOLIA BLVD
Second Line	:	STE 230
City	:	BURBANK
State	:	CA
Zip	:	91506-1762
Country	:	US
Telephone Number	:	818-391-1028
Fax Number	:	818-391-1037

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	05/18/2011

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