Provider Demographics
NPI:1528205804
Name:HUYNH, TU VAN (DDS)
Entity Type:Individual
Prefix:
First Name:TU
Middle Name:VAN
Last Name:HUYNH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-2407
Mailing Address - Country:US
Mailing Address - Phone:714-535-0998
Mailing Address - Fax:714-535-1065
Practice Address - Street 1:111 S BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-2407
Practice Address - Country:US
Practice Address - Phone:714-535-0998
Practice Address - Fax:714-535-1065
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD486151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice