Healthcare Provider Details

I. General information

NPI: 1831629443
Provider Name (Legal Business Name): STEPHANIE MINH-THU TAN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22420 IH 35 STE 203
KYLE TX
78640-2656
US

IV. Provider business mailing address

6210 E HWY 290 STE 240
AUSTIN TX
78723-1144
US

V. Phone/Fax

Practice location:
  • Phone: 512-272-4636
  • Fax: 512-406-7327
Mailing address:
  • Phone: 512-338-3826
  • Fax: 512-406-6216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS6003
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: