Healthcare Provider Details

I. General information

NPI: 1376515437
Provider Name (Legal Business Name): DIEMHANG KENNISON HUYNH-YOUNES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 S CEDAR CREST BLVD SUITE 1200
ALLENTOWN PA
18103-6256
US

IV. Provider business mailing address

1255 S CEDAR CREST BLVD SUITE 1200
ALLENTOWN PA
18103-6256
US

V. Phone/Fax

Practice location:
  • Phone: 610-437-6222
  • Fax: 610-437-5910
Mailing address:
  • Phone: 610-437-6222
  • Fax: 610-437-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA-002786L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: