Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 036149496 | IL |
N | 207L00000X | Anesthesiologist | MD600854844 | WA |
NPI | 1013112283 |
---|---|
Provider Name | Long Ha Huynh |
First Address | Carbondale, IL 62902-3988 |
Second Address | Carbondale, IL 62901-1462 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2007 |
Last Update Date | 25/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
214881 | MULTI SPECIALTY GROUP PTAN (01) | IL |