Provider Demographics
NPI:1427402908
Name:HUYNH, PHAN XUAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PHAN
Middle Name:XUAN
Last Name:HUYNH
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12268 OLDENBERG CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-9037
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7056 ARCHIBALD AVE STE 105
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-8714
Practice Address - Country:US
Practice Address - Phone:951-407-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2024-03-27
Deactivation Date:2018-06-13
Deactivation Code:
Reactivation Date:2020-09-25
Provider Licenses
StateLicense IDTaxonomies
CADDS1047271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics