Healthcare Provider Details

I. General information

NPI: 1659719532
Provider Name (Legal Business Name): PHOENIX SONOGRAPHIC IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W CLARENDON AVE # 10G
PHOENIX AZ
85013-3416
US

IV. Provider business mailing address

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number99018
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number99018
License Number State

VIII. Authorized Official

Name: RONG YANG
Title or Position: DIRECTOR OF PROFESSIONAL SERVICES
Credential:
Phone: 718-790-2775