Provider Demographics
NPI:1245692490
Name:HUYNH, DEREK HUU
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:HUU
Last Name:HUYNH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DEREK
Other - Middle Name:HUU
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:8200 LONG BEACH BLVD
Mailing Address - Street 2:UNIT D-2
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8200 LONG BEACH BLVD
Practice Address - Street 2:UNIT D-2
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2057
Practice Address - Country:US
Practice Address - Phone:323-537-2837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-27
Last Update Date:2018-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist