Provider Demographics
NPI:1548369069
Name:PHUONG C. HUYNH, DDS, INC.
Entity type:Organization
Organization Name:PHUONG C. HUYNH, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-354-6667
Mailing Address - Street 1:10683 MAGNOLIA AVE STE D
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1893
Mailing Address - Country:US
Mailing Address - Phone:951-354-6667
Mailing Address - Fax:951-354-8768
Practice Address - Street 1:10683 MAGNOLIA AVE STE D
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1893
Practice Address - Country:US
Practice Address - Phone:951-354-6667
Practice Address - Fax:951-354-8768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1687889OtherUNITED CONCORDIA
015916OtherDELTACARE PMI
57734OtherSAFEGUARD