Provider Demographics
NPI:1225075716
Name:HOU, KYUNG HEE (DPM)
Entity Type:Individual
Prefix:
First Name:KYUNG
Middle Name:HEE
Last Name:HOU
Suffix:
Gender:F
Credentials:DPM
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 1630
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92085-1630
Mailing Address - Country:US
Mailing Address - Phone:760-945-0596
Mailing Address - Fax:760-726-8427
Practice Address - Street 1:2201 VISTA GRANDE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-2734
Practice Address - Country:US
Practice Address - Phone:760-945-0596
Practice Address - Fax:760-726-8427
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3182213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE3182OtherPTAN
CA000E31820Medicaid
CAT19279Medicare UPIN
CA000E31820Medicaid