Provider Demographics
NPI:1063561512
Name:HUYNH, TUAN KIM (OD)
Entity type:Individual
Prefix:DR
First Name:TUAN
Middle Name:KIM
Last Name:HUYNH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3131 N GLASSELL ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-1007
Mailing Address - Country:US
Mailing Address - Phone:657-281-2030
Mailing Address - Fax:657-888-6880
Practice Address - Street 1:3131 N GLASSELL ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-1007
Practice Address - Country:US
Practice Address - Phone:657-281-2030
Practice Address - Fax:657-888-6880
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10336T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0103360Medicaid
CAU51086Medicare UPIN
CAOP10336Medicare PIN