Healthcare Provider Details

I. General information

NPI: 1891312807
Provider Name (Legal Business Name): KIMBERLEY THIEN DAO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21214 NORTHWEST FWY
CYPRESS TX
77429-2105
US

IV. Provider business mailing address

13737 NOEL RD STE 1600
DALLAS TX
75240-1374
US

V. Phone/Fax

Practice location:
  • Phone: 832-912-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13600
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: