Basic Information
| Provider Information | |||||||||
| NPI: | 1558364364 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HUYNH | ||||||||
| FirstName: | KHANH | ||||||||
| MiddleName: | DANG | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 902 FROSTWOOD DR | ||||||||
| Address2: | STE 275 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134613573 | ||||||||
| FaxNumber: | 7134681247 | ||||||||
| Practice Location | |||||||||
| Address1: | 902 FROSTWOOD DR | ||||||||
| Address2: | STE 275 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134613573 | ||||||||
| FaxNumber: | 7134681247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | F0258 | TX | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | P00066115 | 01 | RAILROAD MEDICARE | OTHER | 8B8652 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |