Healthcare Provider Details

I. General information

NPI: 1356723605
Provider Name (Legal Business Name): PACIFIC FAMILY MEDICINE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BROADWAY STE 302
MILLBRAE CA
94030-1978
US

IV. Provider business mailing address

1001 BROADWAY SUITE 302
MILLBRAE CA
94030-1977
US

V. Phone/Fax

Practice location:
  • Phone: 650-689-5431
  • Fax:
Mailing address:
  • Phone: 650-689-5431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. THANH HUYNH
Title or Position: MD
Credential: MD
Phone: 650-689-5431