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General NPI Number Information
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NPI Number | 1821493230
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Entity Type | Individual
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Provider Name | JEAN HUYNH PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/28/2014
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 11725 STATE AVE. SUITE 100
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City | RIVERSIDE
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State | CA
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Zip | 92505
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Country | US
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Telephone | 951-352-1700
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Fax | 951-352-9117
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Provider Business Mailing Address
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Address Line | 11725 STATE AVENUE 100
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City | RIVERSIDE
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State | CA
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Zip | 92505
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Country | US
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Telephone | 951-352-1700
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Fax | 951-352-9117
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5614
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 53716
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License Number State | CA
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