Basic Information
Provider Information | |||||||||
NPI: | 1750543328 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DAVE | ||||||||
FirstName: | HINA | ||||||||
MiddleName: | N | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6431 FANNIN ST | ||||||||
Address2: | MSB 7.044 | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 77030 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7135008935 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6410 FANNIN ST STE 1014 | ||||||||
Address2: |   | ||||||||
City: | HOUSTON | ||||||||
State: | TX | ||||||||
PostalCode: | 770305301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8323257080 | ||||||||
FaxNumber: | 7135122239 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2008 | ||||||||
LastUpdateDate: | 08/24/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 08/24/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MT193067 | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 2084N0400X | MD.206461 | LA | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0400X | Q8044 | TX | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0600X | Q8044 | TX | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology |
ID Information
ID | Type | State | Issuer | Description | 04085378 | 05 | MS |   | MEDICAID | 2347233 | 05 | LA |   | MEDICAID |