Provider Demographics
NPI:1366070559
Name:HUYNH, TIEN-PHAT VUONG (MD, PHD)
Entity type:Individual
Prefix:
First Name:TIEN-PHAT
Middle Name:VUONG
Last Name:HUYNH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:PHAT
Other - Middle Name:
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 STEIN PLAZA SUITE 420
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3201
Practice Address - Country:US
Practice Address - Phone:310-825-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1916302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology