Provider Demographics
NPI:1518921790
Name:HUYNH, THAI DANG (MD)
Entity type:Individual
Prefix:DR
First Name:THAI
Middle Name:DANG
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 1:305 SANDY CORNER RD
Mailing Address - Street 2:
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-9535
Mailing Address - Country:US
Mailing Address - Phone:979-543-5510
Mailing Address - Fax:979-543-4137
Practice Address - Street 1:305 SANDY CORNER RD
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-9535
Practice Address - Country:US
Practice Address - Phone:979-543-5510
Practice Address - Fax:979-543-4137
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4004207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX152724401Medicaid
TX110242411OtherRAILROAD GBA - RAILROAD MEDICARE
TX8A9284OtherBC/BS TX#
TX8A9284OtherBC/BS TX#
TXH67232Medicare UPIN
TX152724401Medicaid