Healthcare Provider Details

I. General information

NPI: 1386221554
Provider Name (Legal Business Name): KY BUU HUYNH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SIGMAN RD NE STE 280
CONYERS GA
30012-3947
US

IV. Provider business mailing address

1301 SIGMAN RD NE STE 280
CONYERS GA
30012-3947
US

V. Phone/Fax

Practice location:
  • Phone: 678-413-6278
  • Fax: 678-413-6279
Mailing address:
  • Phone: 678-413-6278
  • Fax: 678-413-6279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number110967
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.48297
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: