Healthcare Provider Details

I. General information

NPI: 1033485495
Provider Name (Legal Business Name): THUY HUYNH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 01/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 GEORGETOWN PLACE SUITE A3
STOCKTON CA
95207
US

IV. Provider business mailing address

900 FULTON AVE SUITE 205
SACRAMENTO CA
95825-4500
US

V. Phone/Fax

Practice location:
  • Phone: 209-955-1139
  • Fax: 209-955-1143
Mailing address:
  • Phone: 916-484-3570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number36454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: