Provider Demographics
NPI:1609255249
Name:WIN, MA KHIN KHIN
Entity type:Individual
Prefix:
First Name:MA KHIN KHIN
Middle Name:
Last Name:WIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BORDEN AVE APT B22
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-1173
Mailing Address - Country:US
Mailing Address - Phone:347-630-5780
Mailing Address - Fax:
Practice Address - Street 1:4 NEWTON AVE
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-1153
Practice Address - Country:US
Practice Address - Phone:607-337-4910
Practice Address - Fax:607-337-4915
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300024208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics