Provider Demographics
NPI:1154486918
Name:HUYNH, PHUONG NGOC (MD)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:NGOC
Last Name:HUYNH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17614 EAGLEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810
Mailing Address - Country:US
Mailing Address - Phone:225-756-2495
Mailing Address - Fax:225-262-2437
Practice Address - Street 1:4502 HIGHWAY 951
Practice Address - Street 2:EASTERN LA MENTAL HEALTH SYSTEM
Practice Address - City:JACKSON
Practice Address - State:LA
Practice Address - Zip Code:70748
Practice Address - Country:US
Practice Address - Phone:225-634-0224
Practice Address - Fax:225-634-0213
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07899R208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F88802Medicare UPIN
5U588Medicare ID - Type Unspecified