Provider Demographics
NPI:1063026821
Name:HUYNH, ANDREW PHUONG
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:PHUONG
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 1:323 N EUCLID ST SPC 158
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-3046
Mailing Address - Country:US
Mailing Address - Phone:714-468-3688
Mailing Address - Fax:
Practice Address - Street 1:323 N EUCLID ST SPC 158
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-3046
Practice Address - Country:US
Practice Address - Phone:714-468-3688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82834183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist