MEDICARE: DR. JUSTIN TAEHWAN KIM MD

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	208600000X	Surgery Physician	A81099	CA
2	208C00000X	Colon & Rectal Surgery Physician	A81099	CA

General Provider Information

NPI Number	:	1043489248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN TAEHWAN KIM MD

Provider Business Mailing Address
First Line	:	7500 KIRBY DR
Second Line	:	#1523
City	:	HOUSTON
State	:	TX
Zip	:	77030-4300
Country	:	US
Telephone Number	:	281-904-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	7500 KIRBY DR
Second Line	:	#1523
City	:	HOUSTON
State	:	TX
Zip	:	77030-4300
Country	:	US
Telephone Number	:	281-904-0144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	02/11/2022

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