Individual provider Active NPI

Ethan Holden Nyein, MD

  • Student in an Organized Health Care Education/Training Program
  • New York, NY
National Provider Identifier
1386221497
Registry record updated May 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1000 10TH Ave
New York, NY 10019-1147
Phone
(212) 523-8366
NPI assigned
Mar 25, 2021
Last updated
May 20, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1000 10TH Ave
New York, NY 10019-1147

Mailing address

1000 10TH Ave
New York, NY 10019-1147
Phone (212) 523-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260108003478 CA Practitioner - Obstetrics/Gynecology 8527544584 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

393 E Walnut St
Pasaden, CA 91188-0001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Dec 1, 2025 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 1, 2025 Accepting new patients

Locations

10800 Magnolia Ave
Riverside, CA 92505
Phone (951) 353-2000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1616630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1386221497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191147",
            "telephone_number": "212-523-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 10TH AVE",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100191147",
            "telephone_number": "212-523-8366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYEIN",
        "first_name": "ETHAN",
        "middle_name": "HOLDEN",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-25",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

Verify at the official NPI Registry.