Provider Demographics
NPI:1902629173
Name:HUYNH, TUAN
Entity type:Individual
Prefix:
First Name:TUAN
Middle Name:
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 1:1001 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5749
Mailing Address - Country:US
Mailing Address - Phone:714-517-7500
Mailing Address - Fax:714-517-9245
Practice Address - Street 1:1600 E VERMONT AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5628
Practice Address - Country:US
Practice Address - Phone:714-517-8953
Practice Address - Fax:714-517-9245
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool