Provider Demographics
NPI:1184681272
Name:SIM, SUE JIN (MD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:JIN
Last Name:SIM
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:PO BOX 741169
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77274-1169
Mailing Address - Country:US
Mailing Address - Phone:713-932-3776
Mailing Address - Fax:713-932-3981
Practice Address - Street 1:921 GESSNER
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024
Practice Address - Country:US
Practice Address - Phone:713-242-3000
Practice Address - Fax:713-932-3981
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9809207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G64640Medicare UPIN
TX8D2907Medicare PIN