Provider Demographics
NPI:1649315193
Name:LWIN, WAI (MD)
Entity type:Individual
Prefix:DR
First Name:WAI
Middle Name:
Last Name:LWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:WAI
Other - Last Name:LWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 11867
Mailing Address - Street 2:CMS - CCS
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-3229
Mailing Address - Fax:559-445-2772
Practice Address - Street 1:1221 FULTON MALL
Practice Address - Street 2:CCS, 2ND FLOOR
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1915
Practice Address - Country:US
Practice Address - Phone:559-445-3207
Practice Address - Fax:559-445-3253
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53369208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics