Healthcare Provider Details

I. General information

NPI: 1053520296
Provider Name (Legal Business Name): TRAN HUYEN THI LY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 N CENTRAL EXPY SUITE 430
DALLAS TX
75231-5927
US

IV. Provider business mailing address

9101 N CENTRAL EXPY SUITE 430
DALLAS TX
75231-5927
US

V. Phone/Fax

Practice location:
  • Phone: 214-363-8889
  • Fax: 214-363-9416
Mailing address:
  • Phone: 214-363-8889
  • Fax: 214-363-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberM4311
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: