Provider Demographics
NPI:1457734642
Name:KHINE, SAN KYAW (MD)
Entity Type:Individual
Prefix:DR
First Name:SAN
Middle Name:KYAW
Last Name:KHINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PARK AVE APT 3910
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3783
Mailing Address - Country:US
Mailing Address - Phone:347-567-5055
Mailing Address - Fax:
Practice Address - Street 1:870 PALISADE AVE STE 202
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3445
Practice Address - Country:US
Practice Address - Phone:551-996-9189
Practice Address - Fax:201-836-8042
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA10909800207RN0300X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program