Healthcare Provider Details

I. General information

NPI: 1922480839
Provider Name (Legal Business Name): JEANNIE LOAN HUYNH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 01/21/2022
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 BROADWAY ST UNIT A
PEARLAND TX
77581-5501
US

IV. Provider business mailing address

2304 BRISTOL WATER DR
PEARLAND TX
77584-7869
US

V. Phone/Fax

Practice location:
  • Phone: 281-485-9990
  • Fax:
Mailing address:
  • Phone: 832-344-6761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR7767
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberBP10053996
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: