Provider Demographics
NPI:1629892237
Name:WYNN MEDICAL CENTER PEDIATRICS-MEDICINE TORRANCE
Entity type:Organization
Organization Name:WYNN MEDICAL CENTER PEDIATRICS-MEDICINE TORRANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUYNH
Authorized Official - Middle Name:W
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-573-9003
Mailing Address - Street 1:3655 LOMITA BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-1924
Mailing Address - Country:US
Mailing Address - Phone:310-406-3818
Mailing Address - Fax:
Practice Address - Street 1:3655 LOMITA BLVD STE 211
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-1924
Practice Address - Country:US
Practice Address - Phone:310-406-3818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-11
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty