Provider Demographics
NPI:1023198652
Name:HUYNH, MY TIEV (DMD)
Entity Type:Individual
Prefix:
First Name:MY
Middle Name:TIEV
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9737 SAND HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-8320
Mailing Address - Country:US
Mailing Address - Phone:916-271-4502
Mailing Address - Fax:
Practice Address - Street 1:1355 FLORIN RD
Practice Address - Street 2:3
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-4231
Practice Address - Country:US
Practice Address - Phone:916-428-4039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist