Provider Demographics
NPI:1265960165
Name:HUYNH, CHARLES (PA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 TRELLIS LN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-2078
Mailing Address - Country:US
Mailing Address - Phone:760-443-5317
Mailing Address - Fax:
Practice Address - Street 1:135 TRELLIS LN
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-2078
Practice Address - Country:US
Practice Address - Phone:760-443-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2020-09-30
Deactivation Date:2020-09-21
Deactivation Code:
Reactivation Date:2020-09-30
Provider Licenses
StateLicense IDTaxonomies
10-0816246ZX2200X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic AssistantGroup - Single Specialty