Individual provider Active NPI

Lily Diep Ngoc Nguyen, MSPAS, PA-C

  • Physician Assistant
  • Dallas, TX
National Provider Identifier
1962692848
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA08791 Issued in TX
Practice address
2330 Gus Thomasson Rd.
Dallas, TX 75228
Phone
(972) 349-6090
Fax
(210) 314-5044
NPI assigned
Jul 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA08791 TX Primary

Addresses

Primary practice location

2330 Gus Thomasson Rd.
Dallas, TX 75228

Mailing address

14100 San Pedro Ave Ste 412
San Antonio, TX 78232-2009
Phone (210) 281-8669

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA08791TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Little Spurs Pediatric Urgent Care, PLLC PastSince Sep 12, 2021 Accepting new patients
Singleton Associates PA Physician Assistant PastSince Sep 12, 2021 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1962692848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14100 SAN PEDRO AVE STE 412",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782322009",
            "telephone_number": "210-281-8669",
            "fax_number": "210-314-5044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 GUS THOMASSON RD.",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75228",
            "telephone_number": "972-349-6090",
            "fax_number": "210-314-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "LILY",
        "middle_name": "DIEP NGOC",
        "credential": "MSPAS, PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-27",
        "last_updated": "2021-09-09",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA08791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.