Provider Demographics
NPI:1467550608
Name:HUYNH, THEM (MD)
Entity Type:Individual
Prefix:
First Name:THEM
Middle Name:
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 1:1855 ALUM ROCK AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1398
Mailing Address - Country:US
Mailing Address - Phone:408-254-7524
Mailing Address - Fax:408-254-7526
Practice Address - Street 1:1855 ALUM ROCK AVE STE C
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1398
Practice Address - Country:US
Practice Address - Phone:408-254-7524
Practice Address - Fax:408-254-7526
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38341208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA38341Medicaid
CAA38341Medicaid
A28597Medicare UPIN