Phuc Tuan Huynh, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A7890 Issued in CA

Practice address

2619 S Waterman Ave Ste B
San Bernardino, CA 92408-3737

Phone

(909) 424-0943

Fax

(909) 424-0972

NPI assigned

Jul 7, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Central City Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
  • NPI 1235283094

  General Practice

  Medicare reassignment NPD
• Central City Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Norco, CA
  • NPI 1033488416
  NPD
• Central City Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Upland, CA
  • NPI 1174996318
  NPD
• Rialto Family Medical Group Inc.

  • General Practice Physician
  • Rialto, CA
  • NPI 1326134586

  Family Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1922005602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 S WATERMAN AVE STE B",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083737",
            "telephone_number": "909-424-0943",
            "fax_number": "909-424-0972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2619 S WATERMAN AVE STE B",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083737",
            "telephone_number": "909-424-0943",
            "fax_number": "909-424-0972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUYNH",
        "first_name": "PHUC",
        "middle_name": "TUAN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A7890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00AX78900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roshally Elvy Hutabarat, LVN
• Stacy Hutchins, LMFT
• Ashley Hutchinson
• Kenny Huynh, OD
• Khanh N Huynh, PHARMD
• Hwang Dental Corporation
• Bohye Shelly Hwang-Betat, MD
• Daniel Kyung Hwang, M.D.
• Elyssa Hyde
• John Hynes, LMFT

• Family Medicine Physician in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.