Healthcare Provider Details

I. General information

NPI: 1548080344
Provider Name (Legal Business Name): HUYENLAN DINH, DO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18113 MAGNOLIA ST
FOUNTAIN VALLEY CA
92708-5647
US

IV. Provider business mailing address

26318 PASEO LLUVIA
SAN JUAN CAPISTRANO CA
92675-5058
US

V. Phone/Fax

Practice location:
  • Phone: 302-354-2725
  • Fax:
Mailing address:
  • Phone: 302-354-2725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HUYENLAN DINH
Title or Position: CEO/OWNER
Credential: DO
Phone: 302-354-2725