Healthcare Provider Details

I. General information

NPI: 1659813814
Provider Name (Legal Business Name): AMERICAN DIAGNOSTIC IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S DOBSON RD STE 200
CHANDLER AZ
85286-6169
US

IV. Provider business mailing address

207 W CLARENDON AVE # 10 G
PHOENIX AZ
85013-3435
US

V. Phone/Fax

Practice location:
  • Phone: 718-790-2775
  • Fax: 480-613-3362
Mailing address:
  • Phone: 718-790-2775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number99018
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number99018
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number99018
License Number StateAZ

VIII. Authorized Official

Name: MR. YANG PAN
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential: MSRAS
Phone: 718-790-2772