MEDICARE: UE JIN KIM M.D.

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	2084P0800X	Psychiatry Physician	S0313	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S0313	OTHER	TX	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1982099305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	UE JIN KIM M.D.

Provider Business Mailing Address
First Line	:	12030 BANDERA RD STE 108B
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-4736
Country	:	US
Telephone Number	:	830-271-9063
Fax Number	:

Provider Business Practice Location Address
First Line	:	12030 BANDERA RD STE 108B
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-4736
Country	:	US
Telephone Number	:	830-271-9063
Fax Number	:

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

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	01/04/2024

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