Provider Demographics
NPI:1699718239
Name:KDT, LLC
Entity type:Organization
Organization Name:KDT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DINN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MBA
Authorized Official - Phone:713-668-6690
Mailing Address - Street 1:6109 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-7449
Mailing Address - Country:US
Mailing Address - Phone:713-668-6690
Mailing Address - Fax:713-668-6563
Practice Address - Street 1:6109 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-7449
Practice Address - Country:US
Practice Address - Phone:713-668-6690
Practice Address - Fax:713-668-6563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010371251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX145328401Medicaid
TX679075Medicare Oscar/Certification