Provider Demographics
NPI:1609944933
Name:MYINT, SAN SAN (MD)
Entity Type:Individual
Prefix:
First Name:SAN SAN
Middle Name:
Last Name:MYINT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5676 KIMBERLY ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-3135
Mailing Address - Country:US
Mailing Address - Phone:408-621-1536
Mailing Address - Fax:408-973-8923
Practice Address - Street 1:150 N JACKSON AVE
Practice Address - Street 2:# 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1908
Practice Address - Country:US
Practice Address - Phone:408-621-1536
Practice Address - Fax:408-973-8923
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051537207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 51537OtherCALIFORNIA LICENCE
CAA 51537OtherCALIFORNIA LICENCE