Healthcare Provider Details

I. General information

NPI: 1205763539
Provider Name (Legal Business Name): PHONG MINH HUYNH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SONNY HUYNH

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 BELLE CHASSE HWY
TERRYTOWN LA
70056-7127
US

IV. Provider business mailing address

2005 BRIGHTON PL
HARVEY LA
70058-1415
US

V. Phone/Fax

Practice location:
  • Phone: 504-392-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: