Provider Demographics
NPI:1497855266
Name:HUYNH, JACK SANG VAN (DC)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:SANG VAN
Last Name:HUYNH
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SERRA WAY
Mailing Address - Street 2:STE 16
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-5245
Mailing Address - Country:US
Mailing Address - Phone:408-836-7200
Mailing Address - Fax:408-649-3068
Practice Address - Street 1:200 SERRA WAY
Practice Address - Street 2:STE 16
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5245
Practice Address - Country:US
Practice Address - Phone:408-263-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29130111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497855266Medicaid