Provider Demographics
NPI:1598091803
Name:HUYNH, NICHOLAS (LAC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 E LOS ANGELES AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7706
Mailing Address - Country:US
Mailing Address - Phone:805-578-2265
Mailing Address - Fax:
Practice Address - Street 1:495 E LOS ANGELES AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7706
Practice Address - Country:US
Practice Address - Phone:805-578-2265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 7744171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist