Provider Demographics
NPI:1033298963
Name:HUYNH, DAT TAN (MD)
Entity Type:Individual
Prefix:MR
First Name:DAT
Middle Name:TAN
Last Name:HUYNH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 BURDETTE DRIVE,
Mailing Address - Street 2:SUITE N
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121
Mailing Address - Country:US
Mailing Address - Phone:408-270-4582
Mailing Address - Fax:
Practice Address - Street 1:1661 BURDETTE DR
Practice Address - Street 2:SUITE N
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1613
Practice Address - Country:US
Practice Address - Phone:408-270-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA500710207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A500710Medicaid
CA00A500710Medicaid
CAD64335Medicare UPIN