Healthcare Provider Details

I. General information

NPI: 1043299076
Provider Name (Legal Business Name): THANH TUYEN THI HUYNH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

U.S. NAVAL HOSPITAL
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

6278 PASEO CALLADO
CARLSBAD CA
92009-1906
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1356
  • Fax:
Mailing address:
  • Phone: 760-268-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG77376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: