Provider Demographics
NPI:1740549476
Name:KYAW MOE MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:KYAW MOE MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYAW
Authorized Official - Middle Name:
Authorized Official - Last Name:MOE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-988-7550
Mailing Address - Street 1:22 ODYSSEY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3186
Mailing Address - Country:US
Mailing Address - Phone:949-988-7550
Mailing Address - Fax:949-988-7551
Practice Address - Street 1:22 ODYSSEY
Practice Address - Street 2:SUITE 115
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3186
Practice Address - Country:US
Practice Address - Phone:949-988-7550
Practice Address - Fax:949-988-7551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109324207RN0300X
CAA10934207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty