Coastline Medical Center, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

19541 Issued in MS

Legal business name

COASTLINE MEDICAL CENTER, PLLC

Practice address

10536 Auto Mall Pkwy
Suite a
Diberville, MS 39540-3742

Phone

(228) 396-0333

Fax

(228) 396-4060

NPI assigned

Apr 12, 2007

Last updated

Jan 4, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nguyen Phong Huynh, D.O

Title

Physician

Phone

(228) 396-0333

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294099200000",
    "number": "1952525859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10536 AUTO MALL PKWY",
            "address_2": "A",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395403742",
            "telephone_number": "228-396-0333",
            "fax_number": "228-396-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10536 AUTO MALL PKWY",
            "address_2": "SUITE A",
            "city": "DIBERVILLE",
            "state": "MS",
            "postal_code": "395403742",
            "telephone_number": "228-396-0333",
            "fax_number": "228-396-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTLINE MEDICAL CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2011-01-04",
        "status": "A",
        "authorized_official_last_name": "HUYNH",
        "authorized_official_first_name": "NGUYEN",
        "authorized_official_middle_name": "PHONG",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "228-396-0333",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "19050",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MS",
            "license": "19541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR DR. HUYNH",
            "identifier": "1457462954",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI FOR DR. LE",
            "identifier": "1982618310",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in D'Iberville, MS
• Providers in D'Iberville, MS by specialty
• Internal Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.