Healthcare Provider Details

I. General information

NPI: 1245391515
Provider Name (Legal Business Name): ADVANCED RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7715 GARVEY AVE
ROSEMEAD CA
91770-3003
US

IV. Provider business mailing address

7715 GARVEY AVE
ROSEMEAD CA
91770-3003
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-0431
  • Fax: 626-280-6840
Mailing address:
  • Phone: 626-280-0431
  • Fax: 626-280-6840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberC42348
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC42348
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberC42348
License Number StateCA

VIII. Authorized Official

Name: DR. THANH G. PHUNG
Title or Position: OWNER
Credential: M.D.
Phone: 626-280-0431