Provider Demographics
NPI:1336229699
Name:KASSAW, KRISTIN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:KASSAW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4349 MARTIN LUTHER KING BLVD.
Mailing Address - Street 2:SUITE 1001 E , HEALTH 2 BLDG
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77204-3074
Mailing Address - Country:US
Mailing Address - Phone:713-743-9682
Mailing Address - Fax:713-743-1049
Practice Address - Street 1:4349 MARTIN LUTHER KING BLVD.
Practice Address - Street 2:SUITE 1001 E , HEALTH 2 BLDG
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77204-3074
Practice Address - Country:US
Practice Address - Phone:713-743-9682
Practice Address - Fax:713-743-1049
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK77792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145915801Medicaid
TX145915801Medicaid
TX87506JMedicare PIN