Provider Demographics
NPI:1063613578
Name:WIN, SANDAR (MD)
Entity type:Individual
Prefix:
First Name:SANDAR
Middle Name:
Last Name:WIN
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 1:811 E 11TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4872
Mailing Address - Country:US
Mailing Address - Phone:909-931-5106
Mailing Address - Fax:909-931-5029
Practice Address - Street 1:811 E 11TH ST STE 205
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4872
Practice Address - Country:US
Practice Address - Phone:909-931-5106
Practice Address - Fax:909-931-5029
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 100405207Q00000X
MI4301090050282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No282N00000XHospitalsGeneral Acute Care Hospital