Provider Demographics
NPI:1811956956
Name:AMIN, VIDA (MD)
Entity type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:AMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:VIDA
Other - Middle Name:
Other - Last Name:AMIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
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:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:7120 BOULEVARD 26
Practice Address - Street 2:
Practice Address - City:RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8608
Practice Address - Country:US
Practice Address - Phone:817-347-8025
Practice Address - Fax:817-347-8001
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1467208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176277505Medicaid
TX176277506OtherCSHCN
I38534Medicare UPIN
TX176277505Medicaid