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NPI Code Detail

MEDICARE: PHI TAN HUYNH MD

MEDICARE: PHI TAN HUYNH MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianA91806CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598742413
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHI TAN HUYNH MD
Provider Business Mailing Address
First Line : 1901 W KETTLEMAN LN
Second Line : SUITE 200
City : LODI
State : CA
Zip : 95242-4337
Country : US
Telephone Number : 209-334-8540
Fax Number : 209-368-2885
Provider Business Practice Location Address
First Line : 1901 W KETTLEMAN LN
Second Line : SUITE 200
City : LODI
State : CA
Zip : 95242-4337
Country : US
Telephone Number : 209-334-8540
Fax Number : 209-368-2885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 03/12/2014

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Directions to “ PHI TAN HUYNH MD” Practice Location

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