Provider Demographics
NPI:1013150507
Name:BRAINFLO PA
Entity Type:Organization
Organization Name:BRAINFLO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAESUE
Authorized Official - Middle Name:FLORENCE
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-466-1891
Mailing Address - Street 1:PO BOX 004814
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-0001
Mailing Address - Country:US
Mailing Address - Phone:281-466-1891
Mailing Address - Fax:281-296-9044
Practice Address - Street 1:2180 NORTH LOOP W
Practice Address - Street 2:STE 320
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8014
Practice Address - Country:US
Practice Address - Phone:832-384-1560
Practice Address - Fax:832-384-1585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL54122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXL5412OtherLICENSE /PERMIT #