Basic Information
| Provider Information | |||||||||
| NPI: | 1457933244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | METOE WIN | ||||||||
| FirstName: | KHAING | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2209 GENESEE STREET | ||||||||
| Address2: | BUSINESS OFFICE ROOM 315 | ||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158013282 | ||||||||
| FaxNumber: | 3158018391 | ||||||||
| Practice Location | |||||||||
| Address1: | SISTER ROSE VINCENT FAMILY MEDICINE CENTER | ||||||||
| Address2: | 120 HOBART STREET | ||||||||
| City: | UTICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157981149 | ||||||||
| FaxNumber: | 3157343565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2021 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.