Provider Demographics
NPI:1821097932
Name:SHA, KENNETH KYAW-WIN (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:KYAW-WIN
Last Name:SHA
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 1:136-20 38TH AVENUE
Mailing Address - Street 2:STE. CF-B
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-358-8889
Mailing Address - Fax:718-358-8890
Practice Address - Street 1:136-20 38TH AVENUE
Practice Address - Street 2:STE. CF-B
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-358-8889
Practice Address - Fax:718-358-8890
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197029207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY22R881OtherEMPIRE BC/BS
NY04870HOtherGHI MEDICARE
NY01566729Medicaid
NY22R881Medicare ID - Type Unspecified
NY01566729Medicaid