Healthcare Provider Details

I. General information

NPI: 1720737869
Provider Name (Legal Business Name): NICHOLAS QUOC DUNG HUYNH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 VARNUM AVE
LOWELL MA
01854-2193
US

IV. Provider business mailing address

295 VARNUM AVE
LOWELL MA
01854-2193
US

V. Phone/Fax

Practice location:
  • Phone: 818-624-1715
  • Fax:
Mailing address:
  • Phone: 818-624-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1028135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: