Organization
SD XRAY LLC
Active
Other names
SDXRAY
Organization subpart
No
Provider details
NPI number
Authorized official
BEAU MICHAEL CHUNG DO (MEDICAL DIRECTOR)
(949) 274-8807
Entity
Organization
Contact information
Practice address
8900 GROSSMONT BLVD STE 1, LA MESA, CA 91941-4047
(619) 466-5628
(909) 595-5867
Mailing address
P.O. BOX 4554, DIAMOND BAR, CA 91765
(619) 466-5628
(619) 697-0153
Taxonomy
Speciality
Code
Description
License number
State
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
—
Other
Enumeration date
10/19/2007
Last updated
07/11/2019
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