Provider Demographics
NPI:1992998140
Name:HUYNH, LONG (LAC , MSOM)
Entity type:Individual
Prefix:
First Name:LONG
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:LAC , MSOM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:239 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1913
Mailing Address - Country:US
Mailing Address - Phone:312-420-3050
Mailing Address - Fax:
Practice Address - Street 1:239 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1913
Practice Address - Country:US
Practice Address - Phone:312-889-1239
Practice Address - Fax:312-225-0994
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198.000697171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist