Provider Demographics
NPI:1659077568
Name:HUYNH, TIEN
Entity Type:Individual
Prefix:
First Name:TIEN
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 1:1115 E PIONEER PKWY STE 135
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76010-5875
Mailing Address - Country:US
Mailing Address - Phone:817-460-2580
Mailing Address - Fax:
Practice Address - Street 1:1115 E PIONEER PKWY STE 135
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76010-5875
Practice Address - Country:US
Practice Address - Phone:817-460-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA16375363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant