Provider Demographics
NPI:1649407073
Name:KIM, SOO JUNG (MD PHD)
Entity type:Individual
Prefix:
First Name:SOO JUNG
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1977 BUTLER BLVD STE E6.200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-4101
Mailing Address - Country:US
Mailing Address - Phone:713-798-6131
Mailing Address - Fax:713-798-3252
Practice Address - Street 1:1977 BUTLER BLVD STE E6.200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4101
Practice Address - Country:US
Practice Address - Phone:713-798-6131
Practice Address - Fax:713-798-3252
Is Sole Proprietor?:No
Enumeration Date:2009-06-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269542-1207N00000X
TXQ5678207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology