Provider Demographics
NPI:1700232592
Name:HUYNH, KIM CAROLYN T (NP)
Entity Type:Individual
Prefix:
First Name:KIM CAROLYN
Middle Name:T
Last Name:HUYNH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 F ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-2626
Mailing Address - Country:US
Mailing Address - Phone:619-422-1154
Mailing Address - Fax:619-422-6491
Practice Address - Street 1:345 F ST
Practice Address - Street 2:110
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2626
Practice Address - Country:US
Practice Address - Phone:619-422-1154
Practice Address - Fax:619-422-6491
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004242363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner