Provider Demographics
NPI:1639316714
Name:EAST BAY SPECIAL IMAGING
Entity Type:Organization
Organization Name:EAST BAY SPECIAL IMAGING
Other - Org Name:EAST BAY RADIOLOGY AND PATHOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-587-0650
Mailing Address - Street 1:80 GRAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3791
Mailing Address - Country:US
Mailing Address - Phone:510-587-0650
Mailing Address - Fax:510-587-0649
Practice Address - Street 1:80 GRAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3791
Practice Address - Country:US
Practice Address - Phone:510-587-0650
Practice Address - Fax:510-587-0649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)