Provider Demographics
NPI:1235428871
Name:GAW, LISA WUN KAM (MD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:WUN KAM
Last Name:GAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 S BRAESWOOD BLVD STE 5330
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4477 S LAMAR BLVD STE 400A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1589
Practice Address - Country:US
Practice Address - Phone:512-892-9231
Practice Address - Fax:512-892-9232
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN8654208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX294252601Medicaid
TX294252601Medicaid