Provider Demographics
NPI:1467875690
Name:HUYNH, HAI (OD)
Entity Type:Individual
Prefix:MR
First Name:HAI
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2343 NEW JERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-281-8220
Mailing Address - Fax:
Practice Address - Street 1:5450 THORNWOOD DR.
Practice Address - Street 2:STE. A
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123
Practice Address - Country:US
Practice Address - Phone:408-281-8220
Practice Address - Fax:408-281-2867
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14886 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist