Provider Demographics
NPI:1417377508
Name:HUYNH, ATHENA (DC)
Entity Type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 STORY RD STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2624
Mailing Address - Country:US
Mailing Address - Phone:408-899-4923
Mailing Address - Fax:408-326-2069
Practice Address - Street 1:730 STORY RD STE 4
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2624
Practice Address - Country:US
Practice Address - Phone:408-899-4923
Practice Address - Fax:408-326-2069
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32741111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor