Healthcare Provider Details

I. General information

NPI: 1376637264
Provider Name (Legal Business Name): CENTRAL VALLEY COMMUNITY MEDICAL IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2823 FRESNO ST FRESNO AND R STREETS
FRESNO CA
93721-1324
US

IV. Provider business mailing address

1867 E FIR AVE SUITE 104
FRESNO CA
93720-3841
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-3980
  • Fax:
Mailing address:
  • Phone: 559-325-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK CHANG
Title or Position: TREASURER
Credential: M.D.
Phone: 559-325-5800