| Phuc Huynh, Do, Cpc, Inc. | |
|
2619 S Waterman Ave B San Bernardino CA 92408-3737 | |
| (909) 659-5657 | |
| Not Available |
| Full Name | Phuc Huynh, Do, Cpc, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2619 S Waterman Ave, San Bernardino, California |
| Authorized Official Name and Position | Phuc Huynh (PRESIDENT) |
| Authorized Official Contact | 9096595657 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Phuc Huynh, Do, Cpc, Inc. 2619 S Waterman Ave B San Bernardino CA 92408-3737 Ph: () - | Phuc Huynh, Do, Cpc, Inc. 2619 S Waterman Ave B San Bernardino CA 92408-3737 Ph: (909) 659-5657 |
| NPI Number | 1922260389 |
|---|---|
| Provider Enumeration Date | 06/27/2008 |
| Last Update Date | 06/27/2008 |
| Medicare PECOS PAC ID | 1052467412 |
|---|---|
| Medicare Enrollment ID | O20091007000386 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922260389 | NPI | - | NPPES |
| 00AX78900 | Medicaid | CA | |
| 020A78904 | Other | CA | MEDICARE ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A7890 (California) | Primary |
| Provider Name | Phuc Tuan Huynh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922005602 PECOS PAC ID: 9830160936 Enrollment ID: I20040803000737 |
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