Healthcare Provider Details

I. General information

NPI: 1073476974
Provider Name (Legal Business Name): KIM HUYEN HUYNH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE
BROOKLYN NY
11203-2097
US

IV. Provider business mailing address

114 CRANBERRY DR
LIVERPOOL NY
13088-5661
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-5227
  • Fax: 646-640-4356
Mailing address:
  • Phone: 661-803-9986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: