Provider Demographics
NPI:1386863439
Name:ADVANCED CARDIAC IMAGING
Entity Type:Organization
Organization Name:ADVANCED CARDIAC IMAGING
Other - Org Name:ADVANCED NUCLEAR IMAGING
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOAN
Authorized Official - Middle Name:DUY
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:CNMT
Authorized Official - Phone:714-614-5062
Mailing Address - Street 1:15569 BROOKHURST ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7554
Mailing Address - Country:US
Mailing Address - Phone:714-531-3510
Mailing Address - Fax:714-531-3701
Practice Address - Street 1:15569 BROOKHURST ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7554
Practice Address - Country:US
Practice Address - Phone:714-531-3510
Practice Address - Fax:714-531-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7163-30261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7163-30OtherCALIFORNIA DHS LICENSE
CA7163-30OtherCALIFORNIA DHS LICENSE