Provider Demographics
NPI:1356521264
Name:WIN, NYI NYI (DDS)
Entity type:Individual
Prefix:
First Name:NYI
Middle Name:NYI
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 1:9866 GARVEY AVE
Mailing Address - Street 2:STE. # A
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-1289
Mailing Address - Country:US
Mailing Address - Phone:626-350-6222
Mailing Address - Fax:
Practice Address - Street 1:9866 GARVEY AVE
Practice Address - Street 2:STE. # A
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:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice