Provider Demographics
NPI:1649566571
Name:TRAN, HUYNH (MD, DPD)
Entity Type:Individual
Prefix:DR
First Name:HUYNH
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:MD, DPD
Other - Prefix:DR
Other - First Name:WYNN
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9126 VALLEY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1987
Mailing Address - Country:US
Mailing Address - Phone:626-573-9003
Mailing Address - Fax:626-573-0641
Practice Address - Street 1:9126 VALLEY BLVD STE B
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1987
Practice Address - Country:US
Practice Address - Phone:626-573-9003
Practice Address - Fax:626-573-0641
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2018-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301099658207N00000X, 207R00000X
FLME114761207N00000X, 207R00000X
CAA137091207N00000X, 207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA137091Medicaid