Provider Demographics
NPI:1427806272
Name:WYNN MEDICAL CENTER RHEUMATOLOGY-DERMATOLOGY
Entity type:Organization
Organization Name:WYNN MEDICAL CENTER RHEUMATOLOGY-DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HUYNH
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:616-990-0782
Mailing Address - Street 1:9126 VALLEY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1987
Mailing Address - Country:US
Mailing Address - Phone:626-573-9003
Mailing Address - Fax:
Practice Address - Street 1:11420 RAMONA BLVD STE A
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2743
Practice Address - Country:US
Practice Address - Phone:626-573-9003
Practice Address - Fax:626-573-0641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty