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General NPI Number Information
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NPI Number | 1831051879
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Entity Type | Organization
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Legal Business Name | EXCEL IMAGING CENTER WEST COVINA INC.
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Dates
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Enumeration Date | 11/28/2025
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 536 S GLENDORA AVE
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City | WEST COVINA
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State | CA
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Zip | 91790-3022
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Country | US
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Telephone | 714-583-8126
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Fax | 714-583-8148
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Provider Business Mailing Address
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Address Line | 13071 BROOKHURST ST STE 100
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City | GARDEN GROVE
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State | CA
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Zip | 92843-5514
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Country | US
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Telephone | 714-583-8126
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Fax | 714-583-8148
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KENNY PHAN
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Credential |
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Telephone | 714-583-8126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number |
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License Number State |
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