Provider Demographics
NPI:1962500926
Name:WIN, MYO (DDS)
Entity Type:Individual
Prefix:
First Name:MYO
Middle Name:
Last Name:WIN
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 1:448 W PALM DR
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-8310
Mailing Address - Country:US
Mailing Address - Phone:626-447-7649
Mailing Address - Fax:626-350-9711
Practice Address - Street 1:9866 GARVEY AVE STE A
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1289
Practice Address - Country:US
Practice Address - Phone:626-350-6222
Practice Address - Fax:626-350-9881
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA472091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice