=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770599672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LANNIE VUONG-HUYNH M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 04/26/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11645 BISCAYNE BLVD SUITE 103-104
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-538-8835
-----------------------------------------------------
Fax | 305-891-3496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11645 BISCAYNE BLVD SUITE 207
-----------------------------------------------------
City | NORTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33181-3155
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-538-8835
-----------------------------------------------------
Fax | 954-538-1794
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME78327
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------