Provider Demographics
NPI:1073654232
Name:GOLDEN GATE RADIOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:GOLDEN GATE RADIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:STEVEN CHOI
Authorized Official - Last Name:ENG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:415-677-2320
Mailing Address - Street 1:845 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4851
Mailing Address - Country:US
Mailing Address - Phone:415-677-2320
Mailing Address - Fax:415-677-2444
Practice Address - Street 1:845 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4851
Practice Address - Country:US
Practice Address - Phone:415-677-2320
Practice Address - Fax:415-677-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0104640Medicaid
CADF8009Medicare PIN
CAGR0104640Medicaid