=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346108537
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STARBOARD DYNAMICS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/14/2026
-----------------------------------------------------
Last Update Date | 01/14/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10402 TRASK AVE STE C
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-3207
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-675-8030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 8464
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92728-8464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-675-8030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | THOMAS LE
-----------------------------------------------------
Credential | RADIOLOGY TECHNICIAN
-----------------------------------------------------
Telephone | 714-675-8030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 247100000X
-----------------------------------------------------
Taxonomy Name | Radiologic Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------