Provider Demographics
NPI:1609212885
Name:KIM, SHARON R (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:R
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 1:1016 STUDER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-3259
Mailing Address - Country:US
Mailing Address - Phone:832-746-7654
Mailing Address - Fax:
Practice Address - Street 1:27700 NORTHWEST FWY STE 490
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-8104
Practice Address - Country:US
Practice Address - Phone:281-895-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR0046207N00000X, 207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX392721201Medicaid
TX392721203Medicaid
TX392721202Medicaid