Basic Information
Provider Information | |||||||||
NPI: | 1760687107 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HUYNH | ||||||||
FirstName: | ADRIC | ||||||||
MiddleName: | H | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | B.S.,M.S.,M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | DEPT 34929 | ||||||||
Address2: | P.O. BOX 39000 | ||||||||
City: | SAN FRANCISCO | ||||||||
State: | CA | ||||||||
PostalCode: | 941390001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9259522828 | ||||||||
FaxNumber: | 9259522850 | ||||||||
Practice Location | |||||||||
Address1: | 2400 BALFOUR RD | ||||||||
Address2: | SUITE 120 | ||||||||
City: | BRENTWOOD | ||||||||
State: | CA | ||||||||
PostalCode: | 945134945 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9253088112 | ||||||||
FaxNumber: | 9253088710 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/16/2007 | ||||||||
LastUpdateDate: | 09/17/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0116019122 | VA | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | A114868 | CA | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | P01064775 | 01 | CA | RAILROAD MEDICARE | OTHER | 1760687107 | 05 | CA |   | MEDICAID |