Provider Demographics
NPI:1679630545
Name:HUYNH, TAN CANH (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAN
Middle Name:CANH
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 1:8227 BOLSA AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWAY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92655-1233
Mailing Address - Country:US
Mailing Address - Phone:714-895-5568
Mailing Address - Fax:714-895-5578
Practice Address - Street 1:8227 BOLSA AVE
Practice Address - Street 2:
Practice Address - City:MIDWAY CITY
Practice Address - State:CA
Practice Address - Zip Code:92655-1233
Practice Address - Country:US
Practice Address - Phone:714-895-5568
Practice Address - Fax:714-895-5578
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA466091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice