MEDICARE: MYAT MIN HTUT, DDS, INC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1316587793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MYAT MIN HTUT, DDS, INC

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	:	CEO
Name	:	MYAT HTUT
Credential	:
Telephone Number	:	626-466-5492

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	05/10/2020

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