Provider Demographics
NPI:1518999226
Name:KAISSI, KAHTAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KAHTAN
Middle Name:A
Last Name:KAISSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-3949
Mailing Address - Country:US
Mailing Address - Phone:409-722-3437
Mailing Address - Fax:409-722-1281
Practice Address - Street 1:1300 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-3949
Practice Address - Country:US
Practice Address - Phone:409-722-3437
Practice Address - Fax:409-722-1281
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0970154-01Medicaid
TX110199747OtherMEDICARE RAILROAD
TX8B4030OtherBCBS PROVIDER ID
TX8B4030OtherBCBS PROVIDER ID
G33367Medicare UPIN
TX0970154-01Medicaid