Healthcare Provider Details

I. General information

NPI: 1326972191
Provider Name (Legal Business Name): VIVIAN HUYNH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 BOONE BLVD STE 100
VIENNA VA
22182-2670
US

IV. Provider business mailing address

4110 TAYLOR DR
FAIRFAX VA
22032-1347
US

V. Phone/Fax

Practice location:
  • Phone: 703-745-5055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401420091
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: