Healthcare Provider Details

I. General information

NPI: 1376689075
Provider Name (Legal Business Name): PHAN K. HUYNH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S NEW YORK AVE SUITE 101
ATLANTIC CITY NJ
08401-8012
US

IV. Provider business mailing address

8 S WINDSOR AVE
ATLANTIC CITY NJ
08401-5812
US

V. Phone/Fax

Practice location:
  • Phone: 609-345-1155
  • Fax: 609-345-5323
Mailing address:
  • Phone: 609-345-1155
  • Fax: 609-345-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI019403
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: