Healthcare Provider Details

I. General information

NPI: 1750070140
Provider Name (Legal Business Name): HUY DOAN CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9888 GENESEE AVE
LA JOLLA CA
92037-1205
US

IV. Provider business mailing address

14418 NORWALK CT
POWAY CA
92064-3303
US

V. Phone/Fax

Practice location:
  • Phone: 858-824-8247
  • Fax:
Mailing address:
  • Phone: 832-341-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number119019-0016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: