=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669614491
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRECISION DIAGNOSTIC OF LAKE WORTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2009
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2311 10TH AVENUE NORTH STE 2
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-623-8346
-----------------------------------------------------
Fax | 561-623-8347
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2311 10TH AVENUE NORTH STE 2
-----------------------------------------------------
City | LAKE WORTH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33461
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-623-8346
-----------------------------------------------------
Fax | 561-623-8347
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. BRIAN CHAN-A-SUE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 561-452-2288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM1200X
-----------------------------------------------------
Taxonomy Name | Magnetic Resonance Imaging (MRI) Clinic/Center
-----------------------------------------------------
License Number | FILE # 8803
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------