Provider Demographics
NPI:1891003083
Name:SORAN HONG SHIN
Entity Type:Organization
Organization Name:SORAN HONG SHIN
Other - Org Name:SORAN HONG, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SORAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-658-1144
Mailing Address - Street 1:PO BOX 131095
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77219-1095
Mailing Address - Country:US
Mailing Address - Phone:713-658-1144
Mailing Address - Fax:713-658-1154
Practice Address - Street 1:2000 CRAWFORD ST
Practice Address - Street 2:SUITE 1125
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-9000
Practice Address - Country:US
Practice Address - Phone:713-658-1144
Practice Address - Fax:713-658-1154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB119530OtherMEDICARE PTAN