Provider Demographics
NPI:1447502661
Name:LARSON, HANH HUYNH (DO)
Entity type:Individual
Prefix:DR
First Name:HANH
Middle Name:HUYNH
Last Name:LARSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3110 CHINO AVE STE 150A
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-1295
Mailing Address - Country:US
Mailing Address - Phone:909-630-7940
Mailing Address - Fax:909-469-2108
Practice Address - Street 1:3110 CHINO AVE STE 150A
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-1295
Practice Address - Country:US
Practice Address - Phone:909-630-7940
Practice Address - Fax:909-469-2108
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13073207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447502661Medicaid
CACB258665OtherPTAN SO. CAL
CAFL4337146OtherDEA