Healthcare Provider Details

I. General information

NPI: 1164634069
Provider Name (Legal Business Name): HOLLYWOOD CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 WEST ROAD, STE. 151
HOUSTON TX
77064
US

IV. Provider business mailing address

9211 WEST ROAD, STE. 151
HOUSTON TX
77064
US

V. Phone/Fax

Practice location:
  • Phone: 281-894-7210
  • Fax:
Mailing address:
  • Phone: 281-894-7210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number21179
License Number StateTX

VIII. Authorized Official

Name: DR. VI G HUYNH
Title or Position: PRESIDENT
Credential: DMD
Phone: 281-894-7210