MEDICARE: SAN DIEGO DIAGNOSTIC RADIOLOGY MEDICAL GROUP INC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2085B0100X	Body Imaging Physician
2	2085N0700X	Neuroradiology Physician
3	2085R0204X	Vascular & Interventional Radiology Physician
4	2085U0001X	Diagnostic Ultrasound Physician
5	2085N0904X	Nuclear Radiology Physician
6	2085P0229X	Pediatric Radiology Physician
7	2085R0001X	Radiation Oncology Physician
8	2085R0203X	Therapeutic Radiology Physician
9	208VP0000X	Pain Medicine Physician
10	208VP0014X	Interventional Pain Medicine Physician
11	207U00000X	Nuclear Medicine Physician
12	207UN0901X	Nuclear Cardiology Physician
13	207UN0902X	Nuclear Imaging & Therapy Physician
14	2085R0202X	Diagnostic Radiology Physician

NPI Number	:	1134150949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN DIEGO DIAGNOSTIC RADIOLOGY MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 23540
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92193-3540
Country	:	US
Telephone Number	:	858-565-0950
Fax Number	:	858-244-1100

Provider Business Practice Location Address
First Line	:	3075 HEALTH CENTER DR
Second Line	:	SHARP MEMORIAL OUTPATIENT PAVILLIONS
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2773
Country	:	US
Telephone Number	:	858-939-5091
Fax Number	:	858-939-5078

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	NORMAN C. CHEN
Credential	:	MD
Telephone Number	:	858-565-0950

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	04/21/2017

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

3075 HEALTH CENTER DR STE 102
SAN DIEGO, CA
92123-2773