Provider Demographics
NPI:1780372318
Name:GOH, PRISCILLA LYN-YI (MD)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:LYN-YI
Last Name:GOH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 EL PASO DRIVE
Mailing Address - Street 2:MALL STOP CODE 51017
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79905
Mailing Address - Country:US
Mailing Address - Phone:915-215-5690
Mailing Address - Fax:
Practice Address - Street 1:2000 WOODROW BEAN TRANSMOUNTAIN DRIVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911
Practice Address - Country:US
Practice Address - Phone:915-215-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2024-12-18
Deactivation Date:2023-12-07
Deactivation Code:
Reactivation Date:2023-12-27
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXBP10085775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program