Organization
MT HOUSTON MEDICAL CLINIC
Active
Other names
Mt Houston Medical Clinic, Hui Jun Park, DC PC
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SANDRA ANN SHIRAH ADMINISTRATOR (ADMIN/CREDENTIALING SUPERVISOR)
(832) 683-4132
Entity
Organization
Contact information
Practice address
11703A EASTEX FWY, HOUSTON, TX 77039-6205
(832) 683-4132
(832) 683-4133
Mailing address
11703A EASTEX FWY, HOUSTON, TX 77039-6205
(832) 683-4132
(832) 683-4133
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
J8017
TX
363LF0000X
Family Nurse Practitioner
AP126718
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0078GF
BCBS GRP ID
TX
Enumeration date
04/10/2007
Last updated
10/03/2019
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