Provider Demographics
NPI:1164021341
Name:HUYNH, KIM HUONG (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:HUONG
Last Name:HUYNH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:H
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:111 SMITH RANCH RD
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1939
Mailing Address - Country:US
Mailing Address - Phone:415-491-3011
Mailing Address - Fax:
Practice Address - Street 1:111 SMITH RANCH RD
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1939
Practice Address - Country:US
Practice Address - Phone:415-491-3011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical