Provider Demographics
NPI:1295170397
Name:SHYUNG, DIANE (DO)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:SHYUNG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DIANE
Other - Middle Name:S
Other - Last Name:LUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:3304 COLORADO BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6872
Practice Address - Country:US
Practice Address - Phone:940-565-1510
Practice Address - Fax:940-243-0607
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ6571208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program