Healthcare Provider Details

I. General information

NPI: 1306333190
Provider Name (Legal Business Name): LAILA YAZDANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 CENTRAL EXPY N STE 360
ALLEN TX
75013-6111
US

IV. Provider business mailing address

3600 GASTON AVE STE 550
DALLAS TX
75246-1905
US

V. Phone/Fax

Practice location:
  • Phone: 972-747-6042
  • Fax: 972-747-6043
Mailing address:
  • Phone: 469-800-7976
  • 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 StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS8938
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: