Provider Demographics
NPI:1922187426
Name:HUYNH, CHI (OD)
Entity Type:Individual
Prefix:
First Name:CHI
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 MIRA MESA BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4810
Mailing Address - Country:US
Mailing Address - Phone:858-547-3988
Mailing Address - Fax:844-367-5161
Practice Address - Street 1:9225 MIRA MESA BLVD STE 108
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4810
Practice Address - Country:US
Practice Address - Phone:858-547-3988
Practice Address - Fax:844-367-5161
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12901 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV07444Medicare UPIN