Healthcare Provider Details

I. General information

NPI: 1255741310
Provider Name (Legal Business Name): VENKATA VIJAYA KUMAR DALAI M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 05/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2713 S 74TH ST STE 203
FORT SMITH AR
72903-5171
US

IV. Provider business mailing address

1941 EAST RD SUITE 3230
HOUSTON TX
77054-6010
US

V. Phone/Fax

Practice location:
  • Phone: 479-573-3130
  • Fax:
Mailing address:
  • Phone: 713-486-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberE-12134
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: