Healthcare Provider Details

I. General information

NPI: 1033145685
Provider Name (Legal Business Name): DR. WEILIE KRISTIN S. TJOA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 ST JOSEPH PKWY 1007
HOUSTON TX
77002-8233
US

IV. Provider business mailing address

1315 ST JOSEPH PKWY 1007
HOUSTON TX
77002-8233
US

V. Phone/Fax

Practice location:
  • Phone: 713-951-9996
  • Fax: 713-951-9394
Mailing address:
  • Phone: 713-951-9996
  • Fax: 713-951-9394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG6093
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG6093
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: