Provider Demographics
NPI:1356411771
Name:AYE, SAN M (MD)
Entity type:Individual
Prefix:
First Name:SAN
Middle Name:M
Last Name:AYE
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 1:1717 W BEVERLY BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3971
Mailing Address - Country:US
Mailing Address - Phone:323-728-7218
Mailing Address - Fax:323-723-0057
Practice Address - Street 1:1717 W BEVERLY BLVD
Practice Address - Street 2:STE A
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3971
Practice Address - Country:US
Practice Address - Phone:323-728-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26642207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A266422Medicaid
CA00A266422Medicaid
CA00A266422Medicaid
CA953071629OtherINDIVIDUAL TAX ID NUMBER