Provider Demographics
NPI:1467030023
Name:KASITINON, STACY YUAN (MD, PHD)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:YUAN
Last Name:KASITINON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 N CENTRAL EXPY STE 470
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0803
Mailing Address - Country:US
Mailing Address - Phone:214-506-1115
Mailing Address - Fax:
Practice Address - Street 1:9301 N CENTRAL EXPY STE 470
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0803
Practice Address - Country:US
Practice Address - Phone:214-506-1115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXV3341207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology