Active NPI
Richard Huynh, DMD
- General Practice Dentistry
- Mesa, AZ
National Provider Identifier
1164918157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- D010090
- Practice address
- 1712 S Country Club Dr Ste 104
Mesa, AZ 85210-6046 - Phone
- (480) 376-0593
- NPI assigned
- Jul 2, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D010090 | AZ | Primary |
Addresses
Primary practice location
1712 S Country Club Dr Ste 104
Mesa, AZ 85210-6046
Mailing address
2986 N Oregon St Unit 5
Chandler, AZ 85225-7750
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180927001017 | AZ | Order and Referring Only - Dentist | 4082965264 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D010090 | AZ | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mesa Valley Modern Dentistry, LLP | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530489600000",
"number": "1164918157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2986 N OREGON ST UNIT 5",
"city": "CHANDLER",
"state": "AZ",
"postal_code": "852257750"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1712 S COUNTRY CLUB DR STE 104",
"city": "MESA",
"state": "AZ",
"postal_code": "852106046",
"telephone_number": "480-376-0593"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUYNH",
"first_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-02",
"last_updated": "2018-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "D010090",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.