Provider Demographics
NPI:1831354182
Name:HUYNH, THUCDOAN (MD)
Entity type:Individual
Prefix:
First Name:THUCDOAN
Middle Name:
Last Name:HUYNH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 WAVERLY AVE UNIT 421
Mailing Address - Street 2:
Mailing Address - City:GARRETT PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20896-7521
Mailing Address - Country:US
Mailing Address - Phone:585-851-8482
Mailing Address - Fax:
Practice Address - Street 1:408 JAY ST FL 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5150
Practice Address - Country:US
Practice Address - Phone:855-961-1942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-25
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD043538207Q00000X
NY262858207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400055155Medicare PIN