Provider Demographics
NPI:1801180633
Name:HUYNH, CHRISTINA TRAN (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:TRAN
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3170 WILLOWCREEK RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-4424
Mailing Address - Country:US
Mailing Address - Phone:219-764-7236
Mailing Address - Fax:219-764-4424
Practice Address - Street 1:3170 WILLOWCREEK RD
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4424
Practice Address - Country:US
Practice Address - Phone:219-764-7236
Practice Address - Fax:219-764-7507
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004462A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201242380Medicaid
IN714850079Medicare PIN