NPIMap

Individual provider Active NPI

Grace Wen Kim, M.D.

  • Family Medicine Physician
  • Houston, TX
National Provider Identifier
1609004415
Registry record updated Mar 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
P4469 Issued in TX
Practice address
9055 Katy Fwy Ste 200
Houston, TX 77024-1629
Phone
(713) 461-2915
Fax
(713) 461-5307
NPI assigned
Jun 30, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X P4469 TX Primary

Addresses

Primary practice location

9055 Katy Fwy Ste 200
Houston, TX 77024-1629

Mailing address

PO Box 392929 Ste 200
Pittsburgh, PA 15251-0001
Phone (713) 461-2915

Other identifiers 1

IdentifierTypeStateIssuer
P4469OtherTXTEXAS MEDICAL LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address grace.kim.1@13711.direct.athenahealth.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130426000640 TX Practitioner - Family Practice 7517103195 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Baylor College of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Villagemd of Southeast Texas PAGroup PAC ID 4587947346, 217 clinicians

Practice addresses (Care Compare)

9055 Katy Fwy
Suite 200
Houston, TX 77024-1629
Phone (346) 646-4954

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P4469TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Villagemd of Southeast Texas, PA Family Medicine CurrentSince May 10, 2017 Accepting new patients
Villagemd of Southeast Texas, PA Family Medicine CurrentSince Mar 26, 2023 Accepting new patients
Village Family Pharmacy LLC Current Accepting new patients

Locations

9055 Katy Fwy
Ste 100
Houston, TX 77024
Phone (346) 646-4954

9235 Katy Fwy
Ste 400
Houston, TX 77024
Phone (346) 980-2701

9055 Katy Fwy
Ste 200
Houston, TX 77024
Phone (346) 980-2701

Interoperability endpoints

  • Direct secure messaging: grace.kim.1@13711.direct.athenahealth.com

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679270400000",
    "number": "1609004415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 392929 STE 200",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152510001",
            "telephone_number": "713-461-2915",
            "fax_number": "713-461-5307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9055 KATY FWY STE 200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770241629",
            "telephone_number": "713-461-2915",
            "fax_number": "713-461-5307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "GRACE",
        "middle_name": "WEN",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-30",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "P4469",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEXAS MEDICAL LICENSE",
            "identifier": "P4469",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "grace.kim.1@13711.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Village Medical Texas",
            "address_1": "9055 Katy Fwy Ste 200",
            "city": "Houston",
            "state": "TX",
            "country_code": "US",
            "postal_code": "770241629",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.