1255696415 NPI number — DR. RICHARD HIEU TRUNG HUYNH D.O.

Table of content: DR. RICHARD HIEU TRUNG HUYNH D.O. (NPI 1255696415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255696415 NPI number — DR. RICHARD HIEU TRUNG HUYNH D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUYNH
Provider First Name:
RICHARD HIEU
Provider Middle Name:
TRUNG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUYNH
Provider Other First Name:
RICHARD HIEU
Provider Other Middle Name:
TRUNG
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1255696415
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4190 CITY AVE STE 409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19131-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-871-6694
Provider Business Mailing Address Fax Number:
215-871-6695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4190 CITY AVE STE 409
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19131-1629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-871-6694
Provider Business Practice Location Address Fax Number:
215-871-6695
Provider Enumeration Date:
07/12/2012

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: 208200000X , with the licence number:  OT015574 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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