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General NPI Number Information
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NPI Number | 1548369069
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Entity Type | Organization
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Legal Business Name | PHUONG C. HUYNH, DDS, INC.
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10683 MAGNOLIA AVE STE D
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City | RIVERSIDE
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State | CA
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Zip | 92505-1893
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Country | US
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Telephone | 951-354-6667
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Fax | 951-354-8768
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Provider Business Mailing Address
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Address Line | 10683 MAGNOLIA AVE STE D
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City | RIVERSIDE
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State | CA
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Zip | 92505-1893
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Country | US
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Telephone | 951-354-6667
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Fax | 951-354-8768
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Authorized Official
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Title or Position | CEO
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Name | DR. PHUONG C HUYNH
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Credential | DDS
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Telephone | 951-354-6667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 49336
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License Number State | CA
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