Provider Demographics
NPI:1902096613
Name:HUYNH, JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4460 S LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63127-1647
Mailing Address - Country:US
Mailing Address - Phone:314-843-7557
Mailing Address - Fax:314-849-8671
Practice Address - Street 1:4460 S LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1647
Practice Address - Country:US
Practice Address - Phone:314-843-7557
Practice Address - Fax:314-849-8671
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-29
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007016455207R00000X
MO2009029861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine