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General NPI Number Information
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NPI Number | 1407853674
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Entity Type | Individual
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Provider Name | BETTY CHUNG GRASTY MD
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Gender | Female
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Dates
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Enumeration Date | 07/04/2005
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Last Update Date | 04/24/2022
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Provider Practice Location Address
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Address Line | 6121 N HIGHWAY 161 STE 300
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City | IRVING
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State | TX
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Zip | 75038-2270
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Country | US
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Telephone | 469-647-4004
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Fax | 469-647-4037
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Provider Business Mailing Address
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Address Line | PO BOX 845347
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City | DALLAS
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State | TX
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Zip | 75284-7208
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Country | US
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Telephone | 214-964-0600
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Fax | 214-964-0638
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | L1871
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License Number State | TX
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