Provider Demographics
NPI:1861449126
Name:HUYNH, TRUONG (MD)
Entity Type:Individual
Prefix:
First Name:TRUONG
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 1:133 LITTLETON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3115
Mailing Address - Country:US
Mailing Address - Phone:978-589-6700
Mailing Address - Fax:978-589-6707
Practice Address - Street 1:133 LITTLETON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3115
Practice Address - Country:US
Practice Address - Phone:978-589-6700
Practice Address - Fax:978-589-6707
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238662207Q00000X
IA37467207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0469908Medicaid