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General NPI Number Information
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NPI Number | 1063584696
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Entity Type | Individual
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Provider Name | JUNG SOON KIM M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 6500 NORTH FWY SUITE 116
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City | HOUSTON
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State | TX
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Zip | 77076-2953
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Country | US
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Telephone | 713-697-0041
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Fax | 713-697-6199
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Provider Business Mailing Address
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Address Line | 15 VILLAGE OAKS LN
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City | HOUSTON
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State | TX
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Zip | 77055-6535
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Country | US
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Telephone | 713-647-7844
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G1806
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License Number State | TX
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