Healthcare Provider Details

I. General information

NPI: 1508211368
Provider Name (Legal Business Name): SANDY HUYNH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 11/29/2021
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

7950 SUNFLOWER ST
HIGHLAND CA
92346-5775
US

V. Phone/Fax

Practice location:
  • Phone: 505-948-9510
  • Fax:
Mailing address:
  • Phone: 505-948-9510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA153157
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: