Healthcare Provider Details

I. General information

NPI: 1184125593
Provider Name (Legal Business Name): KIM HOANG THACH HUYNH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 NEPONSET AVE
BOSTON MA
02122-3134
US

IV. Provider business mailing address

58 EDGEMONT RD
BRAINTREE MA
02184-3618
US

V. Phone/Fax

Practice location:
  • Phone: 617-282-3200
  • Fax:
Mailing address:
  • Phone: 339-225-2591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN2316473
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: