Provider Demographics
NPI:1699848507
Name:KYAW, VICTOR A (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:A
Last Name:KYAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 BILSTED WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-3836
Mailing Address - Country:US
Mailing Address - Phone:916-419-0641
Mailing Address - Fax:
Practice Address - Street 1:3701 J ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5542
Practice Address - Country:US
Practice Address - Phone:916-454-2345
Practice Address - Fax:916-454-2968
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A563820Medicaid
G89026Medicare UPIN
CA00A563820Medicaid