Provider Demographics
NPI:1649941402
Name:HUYNH, ANTHONY (PA-C)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 N KIMBALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4747
Mailing Address - Country:US
Mailing Address - Phone:469-375-1525
Mailing Address - Fax:
Practice Address - Street 1:1360 N KIMBALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4747
Practice Address - Country:US
Practice Address - Phone:469-375-1525
Practice Address - Fax:877-330-7366
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA328722363A00000X
TXPA14972363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant