Provider Demographics
NPI:1114963469
Name:HUYNH, CHI TRUC (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHI
Middle Name:TRUC
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6452 S LEE ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-1771
Mailing Address - Country:US
Mailing Address - Phone:678-422-6500
Mailing Address - Fax:678-422-6588
Practice Address - Street 1:6452 S LEE ST
Practice Address - Street 2:SUITE 7
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1771
Practice Address - Country:US
Practice Address - Phone:678-422-6500
Practice Address - Fax:678-422-6588
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0119201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00811159BMedicaid