MEDICARE: DR. CHI TRUC HUYNH DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN011920	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114963469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHI TRUC HUYNH DDS

Provider Business Mailing Address
First Line	:	6452 S LEE ST
Second Line	:	SUITE 7
City	:	MORROW
State	:	GA
Zip	:	30260-1771
Country	:	US
Telephone Number	:	678-422-6500
Fax Number	:	678-422-6588

Provider Business Practice Location Address
First Line	:	6452 S LEE ST
Second Line	:	SUITE 7
City	:	MORROW
State	:	GA
Zip	:	30260-1771
Country	:	US
Telephone Number	:	678-422-6500
Fax Number	:	678-422-6588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	08/31/2007

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