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General NPI Number Information
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NPI Number | 1669045886
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Entity Type | Individual
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Provider Name | KELLEY JOO
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Gender | Female
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Dates
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Enumeration Date | 07/24/2021
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Last Update Date | 07/24/2021
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Provider Practice Location Address
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Address Line | 9506 N SAM HOUSTON PKWY E STE 230
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City | HUMBLE
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State | TX
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Zip | 77396-4903
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Country | US
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Telephone | 832-850-6270
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Fax |
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Provider Business Mailing Address
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Address Line | 8900 LAKES AT 610 DR APT 228
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City | HOUSTON
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State | TX
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Zip | 77054-2880
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Country | US
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Telephone | 832-920-3195
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 37638
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License Number State | TX
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