Provider Demographics
NPI:1275916421
Name:HUYNH, KIM LOAN
Entity Type:Individual
Prefix:
First Name:KIM LOAN
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OLD CEDARBROOK RD
Mailing Address - Street 2:
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2040
Mailing Address - Country:US
Mailing Address - Phone:267-627-2741
Mailing Address - Fax:
Practice Address - Street 1:261 OLD YORK RD STE 215
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3724
Practice Address - Country:US
Practice Address - Phone:267-982-7685
Practice Address - Fax:215-215-9356
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-07
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006416231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist