Healthcare Provider Details

I. General information

NPI: 1689547036
Provider Name (Legal Business Name): THE KIDNEY CLINIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 12/21/2025
Certification Date: 12/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 COLLEGE PARK DR STE 103C
CONROE TX
77384-4001
US

IV. Provider business mailing address

3115 COLLEGE PARK DR STE 103C
THE WOODLANDS TX
77384-4001
US

V. Phone/Fax

Practice location:
  • Phone: 734-985-8467
  • Fax:
Mailing address:
  • Phone: 734-985-8467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: HARINI PAL BEJJANKI
Title or Position: PRESIDENT
Credential: MD
Phone: 936-271-3400