Basic Information
Provider Information
NPI: 1003938192
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HUYNH
FirstName: HIEU
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 10470 OLD PLACERVILLE RD
Address2: SUITE 100
City: SACRAMENTO
State: CA
PostalCode: 958272539
CountryCode: US
TelephoneNumber: 8666810736
FaxNumber:  
Practice Location
Address1: 2800 L ST
Address2: 6TH FLOOR
City: SACRAMENTO
State: CA
PostalCode: 958165616
CountryCode: US
TelephoneNumber: 9168874040
FaxNumber: 9168874045
Other Information
ProviderEnumerationDate: 04/06/2007
LastUpdateDate: 05/22/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X4301087048MIY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
207RC0000XA85410CAN Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


Home