Provider Demographics
NPI:1164612792
Name:HUYNH DENTAL CORPORATION
Entity Type:Organization
Organization Name:HUYNH DENTAL CORPORATION
Other - Org Name:TCH DENTALCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAN
Authorized Official - Middle Name:CANH
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-895-5568
Mailing Address - Street 1:8227 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWAY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92655-1233
Mailing Address - Country:US
Mailing Address - Phone:714-895-5568
Mailing Address - Fax:714-895-5578
Practice Address - Street 1:8227 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655-1233
Practice Address - Country:US
Practice Address - Phone:714-895-5568
Practice Address - Fax:714-895-5578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUYNH DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD466091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG-92320-01OtherMEDICAL PROVIDER NUMBER
CAD46609OtherCALIFORNIA LICENSE NUMBER