Provider Demographics
NPI:1497704415
Name:HUYNH, JEANIE THAO UYEN (DO)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:THAO UYEN
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:THAO UYEN
Other - Middle Name:THI
Other - Last Name:HUYNH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:12121 RICHMOND AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2422
Mailing Address - Country:US
Mailing Address - Phone:281-497-1177
Mailing Address - Fax:281-496-6611
Practice Address - Street 1:12121 RICHMOND AVE STE 214
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2422
Practice Address - Country:US
Practice Address - Phone:281-497-1177
Practice Address - Fax:281-496-6611
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7559207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0069DPOtherBCBS OF TEXAS
TX029918201Medicaid
TXG91756Medicare UPIN
TX00262JMedicare ID - Type Unspecified