Healthcare Provider Details

I. General information

NPI: 1114662970
Provider Name (Legal Business Name): PHUONG LINH HUSSAIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PHUONG LINH HUYNH RN

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4816 E 3RD ST
EAST LOS ANGELES CA
90022-1602
US

IV. Provider business mailing address

517 W 9TH ST
CLAREMONT CA
91711-3740
US

V. Phone/Fax

Practice location:
  • Phone: 323-780-4510
  • Fax:
Mailing address:
  • Phone: 714-808-2404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN61003817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: