Healthcare Provider Details

I. General information

NPI: 1720332000
Provider Name (Legal Business Name): JIN SOOK KIM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6704 STERLING RIDGE DR STE A
THE WOODLANDS TX
77382-2329
US

IV. Provider business mailing address

6704 STERLING RIDGE DR STE A
THE WOODLANDS TX
77382-2329
US

V. Phone/Fax

Practice location:
  • Phone: 281-737-2611
  • Fax:
Mailing address:
  • Phone: 281-737-2611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1181110
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberF340851
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF306114
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: