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General NPI Number Information
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NPI Number | 1164998803
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Entity Type | Individual
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Provider Name | THANH-TAM TIFFANY HUYNH
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Gender | Female
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Dates
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Enumeration Date | 10/20/2018
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 355 PLACENTIA AVE STE 203
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3302
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Country | US
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Telephone | 949-650-0616
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Fax |
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Provider Business Mailing Address
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Address Line | 770 MAGNOLIA AVE STE 2A
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City | CORONA
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State | CA
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Zip | 92879-3122
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Country | US
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Telephone | 626-548-9444
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 56040
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License Number State | CA
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