=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982099305
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | UE JIN KIM M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2015
-----------------------------------------------------
Last Update Date | 01/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12030 BANDERA RD STE 108B
-----------------------------------------------------
City | HELOTES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78023-4736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-271-9063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12030 BANDERA RD STE 108B
-----------------------------------------------------
City | HELOTES
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78023-4736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 830-271-9063
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | S0313
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------