Provider Demographics
NPI:1558469460
Name:KIM, ROSA (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:STE 750
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2727
Mailing Address - Country:US
Mailing Address - Phone:713-524-3434
Mailing Address - Fax:713-524-3220
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 750
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2727
Practice Address - Country:US
Practice Address - Phone:713-524-3434
Practice Address - Fax:713-524-3220
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0333207W00000X, 207WX0108X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0108XAllopathic & Osteopathic PhysiciansOphthalmologyUveitis and Ocular Inflammatory Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1138169Medicaid
TX21017OtherSELECTCARE OF TEXAS
TX10026742OtherAMERIVANTAGE
TX10026742OtherAMERIGROUP
TX8A3190OtherBLUE SHIELD
TX140856902Medicaid
TXG65636OtherSTERLING OPTION ONE
TX140856901Medicaid
TX23747OtherOPTICARE
TX23747OtherOPTICARE
TX140856901Medicaid
TX10026742OtherAMERIVANTAGE
TX8466B0Medicare PIN
TXG65636OtherSTERLING OPTION ONE
LA1138169Medicaid