Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 19355 | TX |
NPI | 1013024538 |
---|---|
Provider Name | Dr. Siv Eang Chhay |
First Address | Grand Prairie, TX 75052 |
Second Address | Grand Prairie, TX 75052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |