MEDICARE: DR. KIMBERLY BUI HUYNH DMD

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	122300000X	Dentist	14106	NC
2	122300000X	Dentist	9936	SC

General Provider Information

NPI Number	:	1356016471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY BUI HUYNH DMD

Provider Business Mailing Address
First Line	:	1001 MARINA VILLAGE DR APT 106
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-2096
Country	:	US
Telephone Number	:	843-345-2474
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 WOODLAWN AVE
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-1775
Country	:	US
Telephone Number	:	704-885-2266
Fax Number	:

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

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	05/29/2025

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