Provider Demographics
NPI:1063044469
Name:HUYNH, CAMTRAN (PA)
Entity Type:Individual
Prefix:
First Name:CAMTRAN
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3930 PENDER DR STE 350
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-0989
Mailing Address - Country:US
Mailing Address - Phone:703-865-8686
Mailing Address - Fax:703-865-6506
Practice Address - Street 1:2501 PARKERS LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3209
Practice Address - Country:US
Practice Address - Phone:703-664-7000
Practice Address - Fax:703-664-7666
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA390200000X
VA0110007743363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program