Healthcare Provider Details

I. General information

NPI: 1265960165
Provider Name (Legal Business Name): CHARLES HUYNH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date: 09/21/2020
Reactivation Date: 09/30/2020

III. Provider practice location address

135 TRELLIS LN
ESCONDIDO CA
92026-2078
US

IV. Provider business mailing address

135 TRELLIS LN
ESCONDIDO CA
92026-2078
US

V. Phone/Fax

Practice location:
  • Phone: 760-443-5317
  • Fax:
Mailing address:
  • Phone: 760-443-5317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number10-0816
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: