Provider Demographics
NPI:1598190589
Name:MISSION IMAGING INC
Entity type:Organization
Organization Name:MISSION IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIENSUP
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-370-0300
Mailing Address - Street 1:900 E WASHINGTON ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-7111
Mailing Address - Country:US
Mailing Address - Phone:909-370-0300
Mailing Address - Fax:
Practice Address - Street 1:900 E WASHINGTON ST
Practice Address - Street 2:SUITE 150
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-7111
Practice Address - Country:US
Practice Address - Phone:909-370-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)