Healthcare Provider Details

I. General information

NPI: 1003236035
Provider Name (Legal Business Name): KRISTIN YEUNG LASSETER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN MICHELLE YEUNG MD

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 MENCHACA RD
AUSTIN TX
78704-6746
US

IV. Provider business mailing address

4022 MENCHACA RD
AUSTIN TX
78704-6746
US

V. Phone/Fax

Practice location:
  • Phone: 512-982-4116
  • Fax: 512-265-9008
Mailing address:
  • Phone: 512-982-4116
  • Fax: 512-265-9008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR8593
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: