Provider Demographics
NPI:1386841468
Name:KIM, SUGENE (MD)
Entity Type:Individual
Prefix:
First Name:SUGENE
Middle Name:
Last Name:KIM
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 1:4185 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:713-792-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6704208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery