1871877209 NPI number — MRS. PHUONG-THAO KRISTY CHOUNLAMANY PA-C

Table of content: MRS. PHUONG-THAO KRISTY CHOUNLAMANY PA-C (NPI 1871877209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871877209 NPI number — MRS. PHUONG-THAO KRISTY CHOUNLAMANY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOUNLAMANY
Provider First Name:
PHUONG-THAO
Provider Middle Name:
KRISTY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHAM
Provider Other First Name:
PHUONG-THAO
Provider Other Middle Name:
KRISTY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871877209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
911230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75391-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-997-8000
Provider Business Mailing Address Fax Number:
972-234-2987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2705 PRINCE GEORGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-2045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-780-0480
Provider Business Practice Location Address Fax Number:
972-780-1453
Provider Enumeration Date:
10/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA05473 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com