Basic Information
| Provider Information | |||||||||
| NPI: | 1346869922 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUYNH | ||||||||
| FirstName: | THUY LIEN | ||||||||
| MiddleName: | LILY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1012 ELM ST APT 10 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951261209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6193425819 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1340 TULLY RD STE 304 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951223055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082713900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2020 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | ASW92423 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.