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General NPI Number Information
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NPI Number | 1003495755
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Entity Type | Individual
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Provider Name | BAO THAI HUYNH
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Gender | Male
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 555 E TACHEVAH DR STE 2W103
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5748
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Country | US
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Telephone | 760-464-0023
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Fax | 760-459-3001
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Provider Business Mailing Address
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Address Line | 555 E TACHEVAH DR STE 2W103
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City | PALM SPRINGS
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State | CA
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Zip | 92262-5748
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Country | US
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Telephone | 760-464-0023
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Fax | 760-459-3001
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A182744
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License Number State | CA
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