Provider Demographics
NPI:1588290704
Name:HUYNH, KEVIN MINH
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MINH
Last Name:HUYNH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11764 FANTASIA CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3814
Mailing Address - Country:US
Mailing Address - Phone:858-231-5116
Mailing Address - Fax:
Practice Address - Street 1:11764 FANTASIA CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3814
Practice Address - Country:US
Practice Address - Phone:858-231-5116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program