Provider Demographics
NPI:1497766364
Name:HUYNH, ANTHONY VU (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:VU
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 1:718 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3319
Mailing Address - Country:US
Mailing Address - Phone:760-337-8500
Mailing Address - Fax:760-337-8572
Practice Address - Street 1:718 S 4TH ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3319
Practice Address - Country:US
Practice Address - Phone:760-337-8500
Practice Address - Fax:760-337-8572
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA69919207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A699190Medicaid
CAH56423Medicare UPIN