Healthcare Provider Details

I. General information

NPI: 1477475036
Provider Name (Legal Business Name): VICKI HUYNH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11205 KNOTT AVE
CYPRESS CA
90630-5489
US

IV. Provider business mailing address

1782 GREEN MEADOW AVE
TUSTIN CA
92780-6661
US

V. Phone/Fax

Practice location:
  • Phone: 714-893-7399
  • Fax:
Mailing address:
  • Phone: 949-302-1631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: