Provider Demographics
NPI:1841324563
Name:KHD HEALTHCARE CLINIC P.A.
Entity type:Organization
Organization Name:KHD HEALTHCARE CLINIC P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:JEANNINE
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-863-7063
Mailing Address - Street 1:1740 W 27TH ST
Mailing Address - Street 2:209
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-863-7063
Mailing Address - Fax:713-863-1725
Practice Address - Street 1:1740 W 27TH ST
Practice Address - Street 2:209
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1440
Practice Address - Country:US
Practice Address - Phone:713-863-7063
Practice Address - Fax:713-863-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5712207RN0300X, 261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Not Answered261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX25358Medicaid
TXE79981Medicare UPIN
TX25358Medicaid