Healthcare Provider Details
I. General information
NPI: 1629892237
Provider Name (Legal Business Name): WYNN MEDICAL CENTER PEDIATRICS-MEDICINE TORRANCE
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/11/2024
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3655 LOMITA BLVD STE 211
TORRANCE CA
90505-1924
US
IV. Provider business mailing address
3655 LOMITA BLVD STE 211
TORRANCE CA
90505-1924
US
V. Phone/Fax
- Phone: 310-406-3818
- Fax:
- Phone: 310-406-3818
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207Q00000X |
| Taxonomy | Family Medicine Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 208000000X |
| Taxonomy | Pediatrics Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
HUYNH
W
TRAN
Title or Position: CEO/FOUNDER
Credential: MD
Phone: 626-573-9003