Healthcare Provider Details

I. General information

NPI: 1235184110
Provider Name (Legal Business Name): JOHN MUIR MAGNETIC IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 YGNACIO VALLEY RD
WALNUT CREEK CA
94598-3122
US

IV. Provider business mailing address

2125 OAK GROVE RD SUITE 200
WALNUT CREEK CA
94598-2536
US

V. Phone/Fax

Practice location:
  • Phone: 925-296-7156
  • Fax: 925-296-7174
Mailing address:
  • Phone: 925-296-7156
  • Fax: 925-296-7174

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: DR. RONALD CHAN
Title or Position: CHAIRMAN
Credential: MD
Phone: 925-296-7156