Healthcare Provider Details

I. General information

NPI: 1144811761
Provider Name (Legal Business Name): HANG THI CAM HUYNH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 S SAN PEDRO ST
LOS ANGELES CA
90011-1121
US

IV. Provider business mailing address

1805 VINE ST APT C
ALHAMBRA CA
91801-6601
US

V. Phone/Fax

Practice location:
  • Phone: 323-233-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: