Provider Demographics
NPI:1679190110
Name:HUYNH-TRAN, THANH LIEM (MD)
Entity Type:Individual
Prefix:
First Name:THANH LIEM
Middle Name:
Last Name:HUYNH-TRAN
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 1:710 WESTWOOD PLZ RM 1-240
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-8353
Mailing Address - Country:US
Mailing Address - Phone:310-825-6681
Mailing Address - Fax:310-206-4733
Practice Address - Street 1:710 WESTWOOD PLZ RM 1-240
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-8353
Practice Address - Country:US
Practice Address - Phone:310-825-6681
Practice Address - Fax:310-206-4733
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1790742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology