MEDICARE: LORA DUNG HUYNH, D.D.S., INC.

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	47733	CA

General Provider Information

NPI Number	:	1962577205
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORA DUNG HUYNH, D.D.S., INC.

Provider Business Mailing Address
First Line	:	639 AZEVEDO CT
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95051-6201
Country	:	US
Telephone Number	:	408-981-0709
Fax Number	:	408-288-7780

Provider Business Practice Location Address
First Line	:	1331 MEDICAL CENTER DR STE H
Second Line	:
City	:	ROHNERT PARK
State	:	CA
Zip	:	94928-2900
Country	:	US
Telephone Number	:	707-585-8599
Fax Number	:	707-585-8281

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DUNG NGOC HUYNH
Credential	:	D.D.S.
Telephone Number	:	408-981-0709

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/22/2020

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