Healthcare Provider Details

I. General information

NPI: 1679585442
Provider Name (Legal Business Name): KIM-NGA HUYNH RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

5717 COLFAX AVE
ALEXANDRIA VA
22311-1011
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1637
  • Fax:
Mailing address:
  • Phone: 571-332-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11894
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202009860
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: