Provider Demographics
NPI:1114181591
Name:KIM, JONGOH (MD)
Entity Type:Individual
Prefix:DR
First Name:JONGOH
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 DASHWOOD DR STE 301
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77081-5360
Mailing Address - Country:US
Mailing Address - Phone:832-637-3320
Mailing Address - Fax:
Practice Address - Street 1:5420 DASHWOOD DR
Practice Address - Street 2:STE 301
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77081-5360
Practice Address - Country:US
Practice Address - Phone:832-968-7003
Practice Address - Fax:832-968-7713
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2022-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6197207R00000X, 207RE0101X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism