Healthcare Provider Details

I. General information

NPI: 1104306810
Provider Name (Legal Business Name): JULIE KIM HUYNH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 JERONIMO RD
IRVINE CA
92618-1908
US

IV. Provider business mailing address

17 LARK
LAKE FOREST CA
92630-1450
US

V. Phone/Fax

Practice location:
  • Phone: 714-516-5480
  • Fax:
Mailing address:
  • Phone: 510-472-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number000000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: