Provider Demographics
NPI:1235181413
Name:HUYNH, PHUNG M (MD)
Entity Type:Individual
Prefix:
First Name:PHUNG
Middle Name:M
Last Name:HUYNH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SEASIDE AVE
Mailing Address - Street 2:AESTETIC CENTER
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-4603
Mailing Address - Country:US
Mailing Address - Phone:203-876-4646
Mailing Address - Fax:
Practice Address - Street 1:300 SEASIDE AVE
Practice Address - Street 2:AESTHETIC CENTER
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-4603
Practice Address - Country:US
Practice Address - Phone:203-876-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044131207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI53571Medicare UPIN