Individual provider Active NPI

Junuk Kim, MD

  • Surgery Physician
  • Shenandoah, TX
National Provider Identifier
1497917553
Registry record updated Mar 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
N3791 Issued in TX
Practice address
129 Vision Park Blvd Ste 212
Shenandoah, TX 77384-3024
Phone
(832) 303-2922
Fax
(866) 923-1223
NPI assigned
Jun 30, 2008
Last updated
Mar 1, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X N3791 TX Primary

Addresses

Primary practice location

129 Vision Park Blvd Ste 212
Shenandoah, TX 77384-3024

Mailing address

129 Vision Park Blvd Ste 212
Shenandoah, TX 77384-3024
Phone (832) 303-2922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091119000648 TX Practitioner - Colorectal Surgery (Proctology)Practitioner - General PracticePractitioner - General Surgery 1759420359 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Colorectal Surgery (Proctology)Also: General Surgery
Education
New York Medical College, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

129 Vision Park Blvd
Suite 212
Shenandoah, TX 77384-3024
Phone (832) 303-2922

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy101
Hernia repair (minimally invasive)1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
N3791TXMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gastroenterology of Texas, PLLC CurrentSince Mar 5, 2023 Accepting new patients
Premier General and Colorectal Surgery, PA CurrentSince Jun 1, 2012 Accepting new patients
Northwest Colon & Rectal Surgery, P.a. PastSince Oct 1, 2005 Accepting new patients

Locations

17115 Red Oak Dr
Ste 211
Houston, TX 77090
Phone (281) 587-2403

837 FM 1960 Rd W
Ste 105
Houston, TX 77090
Phone (281) 453-7158

129 Vision Park Blvd
Ste 212
Shenandoah, TX 77384
Phone (713) 955-2889

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CJFFAD/Endpoint/CJFFAD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1497917553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 VISION PARK BLVD STE 212",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773843024",
            "telephone_number": "832-303-2922",
            "fax_number": "866-923-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 VISION PARK BLVD STE 212",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773843024",
            "telephone_number": "832-303-2922",
            "fax_number": "866-923-1223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "JUNUK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-30",
        "last_updated": "2023-03-01",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "N3791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shenandoah, TX

Sources for this page

Verify at the official NPI Registry.