Healthcare Provider Details

I. General information

NPI: 1538466362
Provider Name (Legal Business Name): JACOB LINH DUY HUYNH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 WESTMINSTER BLVD
WESTMINSTER CA
92683-4001
US

IV. Provider business mailing address

13762 MONROE ST
WESTMINSTER CA
92683-3231
US

V. Phone/Fax

Practice location:
  • Phone: 714-869-8146
  • Fax: 714-891-0530
Mailing address:
  • Phone: 714-272-7120
  • Fax: 714-891-0530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC54539
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberC54539
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: