Provider Demographics
NPI:1811393762
Name:HUYNH, MAXIE (PA-C)
Entity Type:Individual
Prefix:
First Name:MAXIE
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 W GLENOAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91201-1912
Mailing Address - Country:US
Mailing Address - Phone:818-637-2200
Mailing Address - Fax:818-637-2250
Practice Address - Street 1:1511 W GLENOAKS BLVD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91201
Practice Address - Country:US
Practice Address - Phone:818-637-2200
Practice Address - Fax:818-637-2250
Is Sole Proprietor?:No
Enumeration Date:2014-11-04
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005187363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant