Provider Demographics
NPI:1871534461
Name:KYAW, SOE-MOE (MD)
Entity type:Individual
Prefix:DR
First Name:SOE-MOE
Middle Name:
Last Name:KYAW
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 1:876 N MOUNTAIN AVE
Mailing Address - Street 2:STE.200
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4166
Mailing Address - Country:US
Mailing Address - Phone:909-931-3388
Mailing Address - Fax:909-931-7311
Practice Address - Street 1:876 N MOUNTAIN AVE
Practice Address - Street 2:STE.200
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4166
Practice Address - Country:US
Practice Address - Phone:909-931-3388
Practice Address - Fax:909-931-7311
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA679652084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000G78200Medicare ID - Type Unspecified