Individual provider Active NPI

SE Young Um, M.D.

  • Pediatric Adolescent Medicine Physician
  • Richmond, TX
National Provider Identifier
1699754994
Registry record updated Oct 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
License
N2857 Issued in TX
Practice address
1300 Main St
Richmond, TX 77469-3348
Phone
(281) 341-9696
Fax
(281) 762-6370
NPI assigned
Jan 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X N2857 TX Primary
Pediatric Adolescent Medicine Physician 2080A0000X 165285 NY

Addresses

Primary practice location

1300 Main St
Richmond, TX 77469-3348

Mailing address

1300 Main St
Richmond, TX 77469-3348
Phone (281) 341-9696

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
I20090729000216 TX Practitioner - Pediatric Medicine 4082767736 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Community Health Services, Inc CurrentSince Oct 9, 2024 Accepting new patients
Legacy Community Health Services, Inc CurrentSince Oct 9, 2024 Accepting new patients
TMH Physician Associates PLLC Past Accepting new patients
Pediatric Center LTD LLP Past Accepting new patients

Locations

3030 North St
Ste 500
Beaumont, TX 77702
Phone (409) 212-1533

3811 Lyons Ave
Houston, TX 77020
Phone (713) 814-3494

6441 High Star Dr
Houston, TX 77074
Phone (832) 548-5300

12667 Bissonnet St
Houston, TX 77099
Phone (281) 498-6100

3021 Texas Pkwy
Missouri City, TX 77489

14030 Florence Rd
Sugar Land, TX 77498

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1699754994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 MAIN ST",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774693348",
            "telephone_number": "281-341-9696",
            "fax_number": "281-762-6370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 MAIN ST",
            "city": "RICHMOND",
            "state": "TX",
            "postal_code": "774693348",
            "telephone_number": "281-341-9696",
            "fax_number": "281-762-6370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UM",
        "first_name": "SE YOUNG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-13",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "TX",
            "license": "N2857",
            "primary": true
        },
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NY",
            "license": "165285",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, TX

Sources for this page

Verify at the official NPI Registry.