Provider Demographics
NPI:1659959815
Name:PHILIP, JINI SIMON (DPM)
Entity type:Individual
Prefix:DR
First Name:JINI
Middle Name:SIMON
Last Name:PHILIP
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 1:3143 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4367
Mailing Address - Country:US
Mailing Address - Phone:281-980-3668
Mailing Address - Fax:
Practice Address - Street 1:3143 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4367
Practice Address - Country:US
Practice Address - Phone:281-980-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX692113213ES0131X, 213E00000X
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program