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General NPI Number Information
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NPI Number | 1154486918
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Entity Type | Individual
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Provider Name | PHUONG NGOC HUYNH MD
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Gender | Male
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4502 HIGHWAY 951 EASTERN LA MENTAL HEALTH SYSTEM
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City | JACKSON
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State | LA
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Zip | 70748
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Country | US
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Telephone | 225-634-0224
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Fax | 225-634-0213
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Provider Business Mailing Address
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Address Line | 17614 EAGLEWOOD DRIVE
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City | BATON ROUGE
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State | LA
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Zip | 70810
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Country | US
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Telephone | 225-756-2495
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Fax | 225-262-2437
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 07899R
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License Number State | LA
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