=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134222664
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHI HUE HUYNH DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 02/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3302 N BUCKNER BLVD STE 119
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75228
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-320-3466
-----------------------------------------------------
Fax | 214-320-3444
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4709 RAVENDALE DR
-----------------------------------------------------
City | RICHARDSON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-291-4500
-----------------------------------------------------
Fax | 972-271-4511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 19841
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------