=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215181540
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREYSON'S HAT P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2008
-----------------------------------------------------
Last Update Date | 11/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2521 HAZARD ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77019-6719
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-523-3682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14520 MEMORIAL DR # M144
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-5434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-523-3682
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PARTNER
-----------------------------------------------------
Name | DR. HIEU QUANG HUYNH
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 713-523-3622
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 19895
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------