MEDICARE: SAN SAN WIN M.D

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	A77815	CA

General Provider Information

NPI Number	:	1639177355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAN SAN WIN M.D

Provider Business Mailing Address
First Line	:	2 N MAYFAIR AVE
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-1057
Country	:	US
Telephone Number	:	650-756-2269
Fax Number	:	650-756-2269

Provider Business Practice Location Address
First Line	:	1441 POWELL ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94133-3849
Country	:	US
Telephone Number	:	415-292-8650
Fax Number	:	415-292-8666

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	12/14/2021

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