Provider Demographics
NPI:1053526202
Name:HUYNH, LOAN KIM (LCSW)
Entity type:Individual
Prefix:
First Name:LOAN
Middle Name:KIM
Last Name:HUYNH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 SE 35TH PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3370
Mailing Address - Country:US
Mailing Address - Phone:503-494-6579
Mailing Address - Fax:503-494-6143
Practice Address - Street 1:3633 SE 35TH PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3370
Practice Address - Country:US
Practice Address - Phone:503-494-6579
Practice Address - Fax:503-494-6143
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR40121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical