MEDICARE: MY TIEV HUYNH DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	50144	CA

General Provider Information

NPI Number	:	1023198652
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MY TIEV HUYNH DMD

Provider Business Mailing Address
First Line	:	9737 SAND HOLLOW WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95757-8320
Country	:	US
Telephone Number	:	916-271-4502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 FLORIN RD
Second Line	:	3
City	:	SACRAMENTO
State	:	CA
Zip	:	95822-4231
Country	:	US
Telephone Number	:	916-428-4039
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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