Healthcare Provider Details

I. General information

NPI: 1609062801
Provider Name (Legal Business Name): PHUONG-KIEU TRAN HUYNH D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2007
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S HARBOR BLVD
LA HABRA CA
90631-5654
US

IV. Provider business mailing address

1000 VALE TERRACE DR
VISTA CA
92084-5218
US

V. Phone/Fax

Practice location:
  • Phone: 562-264-6000
  • Fax:
Mailing address:
  • Phone: 760-631-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number056031
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number56342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: