Provider Demographics
NPI:1750337341
Name:HUYNH, PAUL TH (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:TH
Last Name:HUYNH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 PARK SIERRA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3071
Mailing Address - Country:US
Mailing Address - Phone:951-687-3400
Mailing Address - Fax:951-687-7630
Practice Address - Street 1:22555 ALESSANDRO BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-8533
Practice Address - Country:US
Practice Address - Phone:951-656-7081
Practice Address - Fax:951-656-1710
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8449207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX84490Medicaid
CAH99481Medicare UPIN
CA00AX84490Medicaid