Healthcare Provider Details

I. General information

NPI: 1336067628
Provider Name (Legal Business Name): KATIE HUYNH
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8014 171ST ST
TINLEY PARK IL
60477-4546
US

IV. Provider business mailing address

1300 W 33RD PL
CHICAGO IL
60608-6462
US

V. Phone/Fax

Practice location:
  • Phone: 708-802-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037156
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: