Provider Demographics
NPI:1457544132
Name:SO, KIN TAK (RVT)
Entity Type:Individual
Prefix:MR
First Name:KIN
Middle Name:TAK
Last Name:SO
Suffix:
Gender:M
Credentials:RVT
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Mailing Address - Street 1:1316 STEVENS AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-4477
Mailing Address - Country:US
Mailing Address - Phone:626-818-7226
Mailing Address - Fax:
Practice Address - Street 1:1316 STEVENS AVE
Practice Address - Street 2:UNIT B
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-4477
Practice Address - Country:US
Practice Address - Phone:626-818-7226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
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Provider Licenses
StateLicense IDTaxonomies
CA1092782471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography