Provider Demographics
NPI:1124286992
Name:SUGENE KIM MD, PA
Entity type:Organization
Organization Name:SUGENE KIM MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-363-4546
Mailing Address - Street 1:4185 TECHNOLOGY FOREST BLVD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-2005
Mailing Address - Country:US
Mailing Address - Phone:281-363-4546
Mailing Address - Fax:281-882-8899
Practice Address - Street 1:4185 TECHNOLOGY FOREST BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2005
Practice Address - Country:US
Practice Address - Phone:281-363-4546
Practice Address - Fax:281-882-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6704208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A4627Medicare PIN