Provider Demographics
NPI:1003495755
Name:HUYNH, BAO THAI
Entity Type:Individual
Prefix:
First Name:BAO
Middle Name:THAI
Last Name:HUYNH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 N PALM CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4402
Mailing Address - Country:US
Mailing Address - Phone:760-561-7344
Mailing Address - Fax:760-327-3052
Practice Address - Street 1:1150 N PALM CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4402
Practice Address - Country:US
Practice Address - Phone:760-561-7344
Practice Address - Fax:760-327-3052
Is Sole Proprietor?:No
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program