Healthcare Provider Details

I. General information

NPI: 1902560253
Provider Name (Legal Business Name): NGOC HUYNH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2021
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date: 10/23/2021
Reactivation Date: 01/26/2022

III. Provider practice location address

550 N FLOWER ST
SANTA ANA CA
92703-2361
US

IV. Provider business mailing address

4080 W 1ST ST SPC 120
SANTA ANA CA
92703-4024
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-4666
  • Fax:
Mailing address:
  • Phone: 714-510-5126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95206613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: