Active NPI
Soe Lwin Wynn, DMD
- Dentist
- Modesto, CA
National Provider Identifier
1750362976
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- CA45058
- Practice address
- 2030 Coffee Rd
Suite # C-4
Modesto, CA 95355-2413 - Phone
- (209) 238-9444
- Fax
- (209) 238-9446
- NPI assigned
- Nov 7, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | CA45058 | CA | Primary |
Addresses
Primary practice location
2030 Coffee Rd
Suite # C-4
Modesto, CA 95355-2413
Mailing address
2030 Coffee Rd
Suite # C-4
Modesto, CA 95355-2413
Phone (209) 238-9444
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160714001339 | CA | Order and Referring Only - Dentist | 7113219957 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CA45058 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Soe L. Wynn, DMD, Inc. | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1750362976",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2030 COFFEE RD",
"address_2": "SUITE # C-4",
"city": "MODESTO",
"state": "CA",
"postal_code": "953552413",
"telephone_number": "209-238-9444",
"fax_number": "209-238-9446"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2030 COFFEE RD",
"address_2": "SUITE # C-4",
"city": "MODESTO",
"state": "CA",
"postal_code": "953552413",
"telephone_number": "209-238-9444",
"fax_number": "209-238-9446"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNN",
"first_name": "SOE",
"middle_name": "LWIN",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-07",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "CA45058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.