| Gulf Coast Clinical Assocaites Llc | |
|
1005 S Shepherd Dr Apt 617 Houston TX 77019-3639 | |
| (832) 837-9556 | |
| Not Available |
| Full Name | Gulf Coast Clinical Assocaites Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1005 S Shepherd Dr Apt 617, Houston, Texas |
| Authorized Official Name and Position | Kwang Kim (OWNER/PROPRIETOR) |
| Authorized Official Contact | 8328379556 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gulf Coast Clinical Assocaites Llc 1005 S Shepherd Dr Apt 617 Houston TX 77019-3639 Ph: () - | Gulf Coast Clinical Assocaites Llc 1005 S Shepherd Dr Apt 617 Houston TX 77019-3639 Ph: (832) 837-9556 |
| NPI Number | 1629707674 |
|---|---|
| Provider Enumeration Date | 06/06/2022 |
| Last Update Date | 09/21/2022 |
| Certification Date | 09/21/2022 |
| Medicare PECOS PAC ID | 1052797883 |
|---|---|
| Medicare Enrollment ID | O20221003001275 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629707674 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Kwang Kim |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093329021 PECOS PAC ID: 1557781135 Enrollment ID: I20201020003480 |
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