Individual
BOTHLAND UNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, MS
Contact information
Practice address
13802 CENTERFIELD DR STE 185, HOUSTON, TX 77070
(281) 737-4425
Mailing address
13802 CENTERFIELD DR STE 185, HOUSTON, TX 77070-6043
(281) 737-4425
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06637
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972812493
BLUE CROSS BLUE SHIELD
TX
05
—
282016901
—
TX
05
—
282016902
—
TX
Enumeration date
09/30/2010
Last updated
03/04/2019
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