Provider Demographics
NPI:1790042067
Name:HUYNH, KHANH (MD)
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:
Last Name:HUYNH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 N RIDGEWOOD ST
Mailing Address - Street 2:APT 418
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-4416
Mailing Address - Country:US
Mailing Address - Phone:312-560-1731
Mailing Address - Fax:
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-37987207P00000X
IN01081835A207P00000X
IL036136113207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine