Provider Demographics
NPI:1144654047
Name:HUYNH, KIET LONG (OD)
Entity type:Individual
Prefix:DR
First Name:KIET
Middle Name:LONG
Last Name:HUYNH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1734 LYDIA CIR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-3512
Mailing Address - Country:US
Mailing Address - Phone:805-304-4551
Mailing Address - Fax:
Practice Address - Street 1:11133 BALBOA BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-4204
Practice Address - Country:US
Practice Address - Phone:805-304-4551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14854152W00000X
NY008068152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist