Provider Demographics
NPI:1760852966
Name:WIN FAMILY MEDICINE INC
Entity type:Organization
Organization Name:WIN FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANDAR
Authorized Official - Middle Name:
Authorized Official - Last Name:WIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-931-5106
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty