Provider Demographics
NPI:1760687107
Name:HUYNH, ADRIC H (BS,MS,MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIC
Middle Name:H
Last Name:HUYNH
Suffix:
Gender:M
Credentials:BS,MS,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT 34929
Mailing Address - Street 2:P.O. BOX 39000
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94139-0001
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:925-952-2850
Practice Address - Street 1:2400 BALFOUR RD
Practice Address - Street 2:SUITE 120
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4945
Practice Address - Country:US
Practice Address - Phone:925-308-8112
Practice Address - Fax:925-308-8710
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019122207Q00000X
CAA114868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01064775OtherRAILROAD MEDICARE
CA1760687107Medicaid
CA1760687107Medicaid