Healthcare Provider Details

I. General information

NPI: 1073654232
Provider Name (Legal Business Name): GOLDEN GATE RADIOLOGY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

845 JACKSON ST
SAN FRANCISCO CA
94133-4851
US

IV. Provider business mailing address

845 JACKSON ST
SAN FRANCISCO CA
94133-4851
US

V. Phone/Fax

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

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: ROGER STEVEN CHOI ENG JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 415-677-2320