Provider Demographics
NPI:1346974656
Name:HUYNH, VIVIAN THI (DMD)
Entity Type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:THI
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11704 ASHLOCK WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-6104
Mailing Address - Country:US
Mailing Address - Phone:360-383-7262
Mailing Address - Fax:
Practice Address - Street 1:9225 MIRA MESA BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4810
Practice Address - Country:US
Practice Address - Phone:858-566-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist