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General NPI Number Information
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NPI Number | 1639362312
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Entity Type | Organization
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Legal Business Name | SOS DOPPLER MOBILE IMAGING
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Dates
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Enumeration Date | 08/24/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 1316 STEVENS AVE UNIT B
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City | SAN GABRIEL
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State | CA
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Zip | 91776-4477
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Country | US
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Telephone | 626-818-7226
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Fax |
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Provider Business Mailing Address
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Address Line | 1316 STEVENS AVE UNIT B
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City | SAN GABRIEL
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State | CA
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Zip | 91776-4477
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Country | US
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Telephone | 626-818-7226
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Fax |
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Authorized Official
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Title or Position | REGISTER VASCULAR TECHNICIAN
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Name | MR. KIN TAK SO
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Credential | R.V.T.
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Telephone | 626-289-2720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2471V0105X
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Taxonomy Name | Vascular Sonography Radiologic Technologist
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License Number | 109278
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License Number State | CA
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