MEDICARE: WEST HOUSTON ORAL SURGERY GROUP PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1033580436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST HOUSTON ORAL SURGERY GROUP PLLC

Provider Business Mailing Address
First Line	:	12121 RICHMOND AVE STE 316
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2437
Country	:	US
Telephone Number	:	281-821-3333
Fax Number	:	281-443-3397

Provider Business Practice Location Address
First Line	:	12121 RICHMOND AVE STE 316
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2437
Country	:	US
Telephone Number	:	281-821-3333
Fax Number	:	281-443-3397

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SEJOON KIM
Credential	:	DDS MD
Telephone Number	:	281-821-3333

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	10/12/2015

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