Healthcare Provider Details

I. General information

NPI: 1619727773
Provider Name (Legal Business Name): DAVID ANH HUY HUYNH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

3312 CHRISTINE DR
LANSING MI
48911-1313
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5375
  • Fax: 708-684-1028
Mailing address:
  • Phone: 517-528-7413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: