MEDICARE: MY LAI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1265380489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MY LAI

Provider Business Mailing Address
First Line	:	3950 N A W GRIMES BLVD
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78665-3540
Country	:	US
Telephone Number	:	512-341-4922
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-9032
Country	:	US
Telephone Number	:	214-648-4866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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Directions to “ MY LAI ” Practice Location

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