Provider Demographics
NPI:1669175857
Name:HUYNH, KELLY (DC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 E MADISON ST APT 425
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5192
Mailing Address - Country:US
Mailing Address - Phone:580-548-7917
Mailing Address - Fax:
Practice Address - Street 1:4814 INTERLAKE AVE N STE C
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-6772
Practice Address - Country:US
Practice Address - Phone:206-652-4807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH61397393111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor