Provider Demographics
NPI:1114052545
Name:HORN, KIM JEANNINE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:JEANNINE
Last Name:HORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 W 27TH ST
Mailing Address - Street 2:209
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1440
Mailing Address - Country:US
Mailing Address - Phone:713-863-7063
Mailing Address - Fax:
Practice Address - Street 1:1740 W 27TH ST
Practice Address - Street 2:209
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1440
Practice Address - Country:US
Practice Address - Phone:713-863-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH5712207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10014568OtherMEDICAID
TX25358Medicaid
TX00J59JMedicare ID - Type Unspecified
TX10014568OtherMEDICAID