Provider Demographics
NPI:1952656621
Name:HUYNH, ANDREW VO (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:VO
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 1:10700 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE #140
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4768
Mailing Address - Country:US
Mailing Address - Phone:310-470-6121
Mailing Address - Fax:
Practice Address - Street 1:10700 SANTA MONICA BLVD
Practice Address - Street 2:SUITE #140
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4768
Practice Address - Country:US
Practice Address - Phone:310-470-6121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA633851223P0221X
MADL11574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist