Provider Demographics
NPI:1275717449
Name:HOUSTON, TUYET MAI DANG (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MISS
First Name:TUYET MAI
Middle Name:DANG
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NEALY BLVD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2023
Mailing Address - Country:US
Mailing Address - Phone:757-225-6727
Mailing Address - Fax:757-764-6884
Practice Address - Street 1:77 NEALY BLVD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665-2023
Practice Address - Country:US
Practice Address - Phone:757-225-6727
Practice Address - Fax:757-764-6884
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01100004043363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVC10269OtherRAILROAD MEDICARE GROUP
WV9930421OtherMEDICARE GROUP #