Provider Demographics
NPI:1023357894
Name:BAKORP, L.L.C.
Entity Type:Organization
Organization Name:BAKORP, L.L.C.
Other - Org Name:PACIFIC MOBILE DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-540-1249
Mailing Address - Street 1:1600 W BROADWAY RD STE 155
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-1138
Mailing Address - Country:US
Mailing Address - Phone:949-487-9500
Mailing Address - Fax:949-487-9400
Practice Address - Street 1:12659 S 125 E STE B
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-5733
Practice Address - Country:US
Practice Address - Phone:801-503-0502
Practice Address - Fax:801-503-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000079136Medicare Oscar/Certification