Healthcare Provider Details

I. General information

NPI: 1033976436
Provider Name (Legal Business Name): DYLAN HUYNH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10412 WAKING CLOUD AVE
LAS VEGAS NV
89129-3247
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 702-964-8256
  • Fax:
Mailing address:
  • Phone: 702-964-8256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2827295
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-17014
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-330816
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: