Provider Demographics
NPI:1164858452
Name:GARCIA, KRISTEN (MD PHD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GARCIA
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:DONGWOOK
Other - Middle Name:
Other - Last Name:KRISTEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PHD
Mailing Address - Street 1:1919 NORTH LOOP W
Mailing Address - Street 2:SUITE 218
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1374
Mailing Address - Country:US
Mailing Address - Phone:713-862-5797
Mailing Address - Fax:713-862-0166
Practice Address - Street 1:1919 NORTH LOOP W
Practice Address - Street 2:SUITE 218
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1374
Practice Address - Country:US
Practice Address - Phone:713-862-5797
Practice Address - Fax:713-862-0166
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10969034207V00000X, 207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1164858452Medicare UPIN