Provider Demographics
NPI:1740382415
Name:MG, KYAW KYAW (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYAW
Middle Name:KYAW
Last Name:MG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9056 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2313
Mailing Address - Country:US
Mailing Address - Phone:626-232-0719
Mailing Address - Fax:
Practice Address - Street 1:11004 LOWER AZUSA RD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-1440
Practice Address - Country:US
Practice Address - Phone:626-575-1191
Practice Address - Fax:626-575-3977
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG 93515-01Medicaid