Provider Demographics
NPI:1255001806
Name:EKG360
Entity Type:Organization
Organization Name:EKG360
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RUEY-KANG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-866-0709
Mailing Address - Street 1:1360 VALLEY VISTA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3953
Mailing Address - Country:US
Mailing Address - Phone:310-866-0709
Mailing Address - Fax:310-755-3108
Practice Address - Street 1:1360 VALLEY VISTA DR STE 203
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3953
Practice Address - Country:US
Practice Address - Phone:310-866-0709
Practice Address - Fax:310-755-3108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory