Provider Demographics
NPI:1689684342
Name:HUYNH, ELIZABETH THAO (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:THAO
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 COYLE AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0301
Mailing Address - Country:US
Mailing Address - Phone:916-339-9699
Mailing Address - Fax:916-339-9628
Practice Address - Street 1:6500 COYLE AVE STE 6
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0301
Practice Address - Country:US
Practice Address - Phone:916-339-9699
Practice Address - Fax:916-339-9628
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1689684342OtherNPI