Provider Demographics
NPI:1295764413
Name:KHRAISH, GINA (MD)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:KHRAISH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 LA CONCHA LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-1801
Mailing Address - Country:US
Mailing Address - Phone:713-790-9082
Mailing Address - Fax:713-790-1664
Practice Address - Street 1:6431 FANNIN ST STE 274
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-704-9389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4492207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170842201Medicaid
TX8S2291OtherBLUE CROSS BLUE SHIELD
TX8S2291OtherBLUE CROSS BLUE SHIELD
TXI05365Medicare UPIN