Provider Demographics
NPI:1124894324
Name:HUYNH, ANH THUC
Entity type:Individual
Prefix:
First Name:ANH
Middle Name:THUC
Last Name:HUYNH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14621 VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:MIDWAY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92655-1066
Mailing Address - Country:US
Mailing Address - Phone:714-340-8558
Mailing Address - Fax:
Practice Address - Street 1:14621 VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655-1066
Practice Address - Country:US
Practice Address - Phone:714-340-8558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
CA1104961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program