Provider Demographics
NPI:1245790559
Name:HUYNH, WALLACE (CRNA)
Entity Type:Individual
Prefix:
First Name:WALLACE
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8135 FOREST LN # 515057
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2472
Mailing Address - Country:US
Mailing Address - Phone:281-571-3543
Mailing Address - Fax:
Practice Address - Street 1:23510 KINGSLAND BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4125
Practice Address - Country:US
Practice Address - Phone:281-571-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141926367500000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered