Healthcare Provider Details

I. General information

NPI: 1356066740
Provider Name (Legal Business Name): ALLIVE ULTRASOUND IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2022
Last Update Date: 10/07/2022
Certification Date: 10/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

767 ACADEMY DR
SOLANA BEACH CA
92075-2031
US

IV. Provider business mailing address

4929 BROOKBURN DR
SAN DIEGO CA
92130-2779
US

V. Phone/Fax

Practice location:
  • Phone: 858-775-2428
  • Fax:
Mailing address:
  • Phone: 858-703-7522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2471V0105X
TaxonomyVascular Sonography Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: CHOONGGOO KANG
Title or Position: CFO
Credential:
Phone: 858-703-7522