Provider Demographics
NPI:1881642155
Name:WIN, HTAY (MD)
Entity Type:Individual
Prefix:DR
First Name:HTAY
Middle Name:
Last Name:WIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HTAY
Other - Middle Name:WIN
Other - Last Name:FANG
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6101
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-0622
Mailing Address - Country:US
Mailing Address - Phone:510-793-1958
Mailing Address - Fax:510-996-6566
Practice Address - Street 1:3458 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1422
Practice Address - Country:US
Practice Address - Phone:510-793-1958
Practice Address - Fax:510-996-6566
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A886381Medicare ID - Type Unspecified
I31721Medicare UPIN