Provider Demographics
NPI:1447482716
Name:HUYHN, AVANSSA KIM (LMP)
Entity type:Individual
Prefix:
First Name:AVANSSA
Middle Name:KIM
Last Name:HUYHN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 EVERGREEN PARK DRIVE SW
Mailing Address - Street 2:APT E6
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502
Mailing Address - Country:US
Mailing Address - Phone:360-352-9100
Mailing Address - Fax:360-352-9108
Practice Address - Street 1:1655 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5735
Practice Address - Country:US
Practice Address - Phone:360-352-9100
Practice Address - Fax:360-352-9108
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60104055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA60104055OtherPRIVATE INSURANCE AND CASH ONLY