Healthcare Provider Details
I. General information
NPI: 1467336438
Provider Name (Legal Business Name): WYNN MEDICAL CENTER GASTROENTEROLOGY
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
9120 VALLEY BLVD
ROSEMEAD CA
91770-1920
US
IV. Provider business mailing address
9120 VALLEY BLVD
ROSEMEAD CA
91770-1920
US
V. Phone/Fax
- Phone: 626-316-8287
- Fax: 626-573-0641
- Phone: 626-316-8287
- Fax: 626-573-0641
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RG0100X |
| Taxonomy | Gastroenterology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
HUYNH
W
TRAN
Title or Position: PRESIDENT
Credential: MD, FACP
Phone: 626-316-8287