Active NPI
Mark Junho Im, MD
- Emergency Medicine Physician
- Houston, TX
National Provider Identifier
1457572679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- M6668
- Practice address
- 1401 St Joseph Pkwy
Houston, TX 77002-8301 - Phone
- (713) 757-1000
- NPI assigned
- May 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | M6668 | TX | Primary |
Addresses
Primary practice location
1401 St Joseph Pkwy
Houston, TX 77002-8301
Mailing address
1306 W Forest Dr
Houston, TX 77043-4524
Phone (832) 545-4560
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 188112003 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M6668 | TX | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1246492800000",
"number": "1457572679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1306 W FOREST DR",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770434524",
"telephone_number": "832-545-4560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 ST JOSEPH PKWY",
"city": "HOUSTON",
"state": "TX",
"postal_code": "770028301",
"telephone_number": "713-757-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IM",
"first_name": "MARK",
"middle_name": "JUNHO",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-02",
"last_updated": "2009-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TX",
"license": "M6668",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "188112003",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.