Healthcare Provider Details

I. General information

NPI: 1780312371
Provider Name (Legal Business Name): SAN DIEGO IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7910 FROST STREET SUITE 100
SAN DIEGO CA
92123-2771
US

IV. Provider business mailing address

P.O. BOX 23540
SAN DIEGO CA
92193-3540
US

V. Phone/Fax

Practice location:
  • Phone: 858-634-5900
  • Fax: 858-634-5990
Mailing address:
  • Phone: 858-565-0950
  • Fax: 858-565-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NORMAN C. CHEN
Title or Position: PRESIDENT/CEO
Credential: MD
Phone: 858-565-0950