Provider Demographics
NPI:1114061280
Name:MEDICAL ULTRASOUND DIAGNOSTIC ALLIANCE INC.
Entity Type:Organization
Organization Name:MEDICAL ULTRASOUND DIAGNOSTIC ALLIANCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAK CHIU
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:626-255-8383
Mailing Address - Street 1:20422 LEAP CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3551
Mailing Address - Country:US
Mailing Address - Phone:626-255-8383
Mailing Address - Fax:909-595-7233
Practice Address - Street 1:20422 LEAP COURT
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-3551
Practice Address - Country:US
Practice Address - Phone:626-255-8383
Practice Address - Fax:909-595-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATG031246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG031OtherIDTF PROVIDER #