Provider Demographics
NPI:1619754025
Name:KYI, MYA THEDA
Entity Type:Individual
Prefix:
First Name:MYA
Middle Name:THEDA
Last Name:KYI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-1518
Mailing Address - Country:US
Mailing Address - Phone:619-255-9164
Mailing Address - Fax:
Practice Address - Street 1:217 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-1518
Practice Address - Country:US
Practice Address - Phone:619-255-9164
Practice Address - Fax:619-434-7308
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily