Provider Demographics
NPI:1649434390
Name:HUYNH, CHAU QUANG (MD)
Entity type:Individual
Prefix:
First Name:CHAU
Middle Name:QUANG
Last Name:HUYNH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 EAST VALENCIA MESA DRIVE
Mailing Address - Street 2:ST JUDE RADIOLOGY MEDICAL GROUP
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835
Mailing Address - Country:US
Mailing Address - Phone:714-922-3978
Mailing Address - Fax:714-446-5908
Practice Address - Street 1:101 EAST VALENCIA MESA DRIVE
Practice Address - Street 2:ST JUDE RADIOLOGY MEDICAL GROUP
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835
Practice Address - Country:US
Practice Address - Phone:714-922-3978
Practice Address - Fax:714-446-5908
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2010-04-13
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Provider Licenses
StateLicense IDTaxonomies
CAA844032085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIMD15261OtherSTATE LICENSE
CAA84403OtherSTATE LICENSE