1891003083 NPI number — SORAN HONG SHIN

Table of content: (NPI 1891003083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891003083 NPI number — SORAN HONG SHIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SORAN HONG SHIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SORAN HONG, MD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891003083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 131095
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77219-1095
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-658-1144
Provider Business Mailing Address Fax Number:
713-658-1154

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 CRAWFORD ST
Provider Second Line Business Practice Location Address:
SUITE 1125
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77002-9000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-658-1144
Provider Business Practice Location Address Fax Number:
713-658-1154
Provider Enumeration Date:
09/22/2010

Additional Information

Authorized Official

Authorized Official Last Name:
HONG
Authorized Official First Name:
SORAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
713-658-1144

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: TXB119530 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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