Active NPI
Hong R Im, D.D.S.
- Dentist
- Manor, TX
National Provider Identifier
1578810164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 32610
- Practice address
- 11808 Ring Dr
Manor, TX 78653-2111 - Phone
- (512) 649-3339
- NPI assigned
- Aug 14, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 32610 | TX | |
| Dentist | 122300000X | 32610 | TX | Primary |
Addresses
Primary practice location
11808 Ring Dr
Manor, TX 78653-2111
Mailing address
8800 Pine Forest Rd
Apt 3203
Pensacola, FL 32534-5309
Phone (954) 295-4701
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 32610 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684800000000",
"number": "1578810164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8800 PINE FOREST RD",
"address_2": "APT 3203",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325345309",
"telephone_number": "954-295-4701"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11808 RING DR",
"city": "MANOR",
"state": "TX",
"postal_code": "786532111",
"telephone_number": "512-649-3339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IM",
"first_name": "HONG",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-14",
"last_updated": "2023-05-23",
"certification_date": "2023-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "32610",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "32610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manor, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.