1154486918 NPI number — DR. PHUONG NGOC HUYNH MD

Table of content: DR. PHUONG NGOC HUYNH MD (NPI 1154486918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154486918 NPI number — DR. PHUONG NGOC HUYNH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUYNH
Provider First Name:
PHUONG
Provider Middle Name:
NGOC
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154486918
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17614 EAGLEWOOD DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
225-756-2495
Provider Business Mailing Address Fax Number:
225-262-2437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4502 HIGHWAY 951
Provider Second Line Business Practice Location Address:
EASTERN LA MENTAL HEALTH SYSTEM
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-634-0224
Provider Business Practice Location Address Fax Number:
225-634-0213
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  07899R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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