Provider Demographics
NPI:1417458845
Name:FOOT AND ANKLE WOUND CARE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FOOT AND ANKLE WOUND CARE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:QUANG
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:669-226-5187
Mailing Address - Street 1:200 JOSE FIGUERES AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1555
Mailing Address - Country:US
Mailing Address - Phone:669-226-5187
Mailing Address - Fax:408-770-3314
Practice Address - Street 1:200 JOSE FIGUERES AVE STE 260
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1555
Practice Address - Country:US
Practice Address - Phone:669-226-5187
Practice Address - Fax:408-770-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5412213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty