Healthcare Provider Details

I. General information

NPI: 1881892941
Provider Name (Legal Business Name): PHUONG N. HUYNH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 11/16/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 TAYLOR AVE FL 2
COLUMBUS OH
43203-1278
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-688-6490
  • Fax: 614-688-6491
Mailing address:
  • Phone: 614-688-6490
  • Fax: 614-688-6491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP3352
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number35095287
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberP3352
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.095287
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: