Provider Demographics
NPI:1720152952
Name:KYI, WIN M (MD)
Entity Type:Individual
Prefix:MR
First Name:WIN
Middle Name:M
Last Name:KYI
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 1:100 W ROSS BLVD STE 2A
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-7217
Mailing Address - Country:US
Mailing Address - Phone:620-227-3141
Mailing Address - Fax:620-227-8095
Practice Address - Street 1:100 ROSS BLVD
Practice Address - Street 2:STE 2A
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801
Practice Address - Country:US
Practice Address - Phone:620-227-3141
Practice Address - Fax:620-227-8095
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0420643207Q00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS10014840AMedicaid
045746Medicare ID - Type Unspecified
KS10014840AMedicaid