Healthcare Provider Details

I. General information

NPI: 1992892103
Provider Name (Legal Business Name): UNITED DIAGNOSTICS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2006
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 E ARROW HWY # A
SAN DIMAS CA
91773-3359
US

IV. Provider business mailing address

284 E ARROW HWY # A
SAN DIMAS CA
91773-3359
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-2999
  • Fax: 909-599-2998
Mailing address:
  • Phone: 909-599-2999
  • Fax: 909-599-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License NumberWILL ISSUE BY AAET
License Number StateNULL

VIII. Authorized Official

Name: MRS. WEN CHEN HWANG
Title or Position: PRESIDENT/CEO
Credential:
Phone: 909-599-2999