# SD XRAY LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SDXRAY
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417146903
- **Authorized official:** BEAU MICHAEL CHUNG DO (MEDICAL DIRECTOR)
- **Authorized official phone:** (949) 274-8807

## Contact information

- **Practice address:** 8900 GROSSMONT BLVD STE 1, LA MESA, CA 91941-4047
- **Practice address phone:** (619) 466-5628
- **Practice address fax:** (909) 595-5867
- **Mailing address:** P.O. BOX 4554, DIAMOND BAR, CA 91765
- **Mailing address phone:** (619) 466-5628
- **Mailing address fax:** (619) 697-0153

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335V00000X | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 10/19/2007
- **Last updated:** 07/11/2019