Healthcare Provider Details

I. General information

NPI: 1730735523
Provider Name (Legal Business Name): VINCENT HUYNH PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 WILSHIRE BLVD STE 1208
LOS ANGELES CA
90024-4005
US

IV. Provider business mailing address

112 E LINDA VISTA AVE
ALHAMBRA CA
91801-4811
US

V. Phone/Fax

Practice location:
  • Phone: 424-260-2974
  • Fax: 424-260-2980
Mailing address:
  • Phone: 626-230-2980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT297011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: