Provider Demographics
NPI:1629349790
Name:KIM, MANSIK (RCS,RVS)
Entity Type:Individual
Prefix:MR
First Name:MANSIK
Middle Name:
Last Name:KIM
Suffix:
Gender:M
Credentials:RCS,RVS
Other - Prefix:
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Mailing Address - Street 1:8831 LONG POINT RD STE 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-3010
Mailing Address - Country:US
Mailing Address - Phone:713-894-1809
Mailing Address - Fax:713-588-1809
Practice Address - Street 1:8831 LONG POINT DR. SUITE #104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-4402
Practice Address - Country:US
Practice Address - Phone:713-894-1809
Practice Address - Fax:713-588-1809
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX000746292471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography