Provider Demographics
NPI:1467126425
Name:BAY MOBILE X-RAY
Entity Type:Organization
Organization Name:BAY MOBILE X-RAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIEN
Authorized Official - Middle Name:DANG
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:669-350-3331
Mailing Address - Street 1:3648 HEATHCOT CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-1442
Mailing Address - Country:US
Mailing Address - Phone:669-350-3331
Mailing Address - Fax:
Practice Address - Street 1:3648 HEATHCOT CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95121-1442
Practice Address - Country:US
Practice Address - Phone:669-350-3331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty