Healthcare Provider Details

I. General information

NPI: 1427409986
Provider Name (Legal Business Name): GOLDEN GATE RADIOLOGY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

386 GELLERT BLVD
DALY CITY CA
94015-2611
US

IV. Provider business mailing address

PO BOX 26750
FRESNO CA
93729-6750
US

V. Phone/Fax

Practice location:
  • Phone: 415-677-2320
  • Fax: 415-677-2444
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROGER ENG
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D.
Phone: 559-455-4109