Provider Demographics
NPI:1639362312
Name:SOS DOPPLER MOBILE IMAGING
Entity Type:Organization
Organization Name:SOS DOPPLER MOBILE IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTER VASCULAR TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:KIN
Authorized Official - Middle Name:TAK
Authorized Official - Last Name:SO
Authorized Official - Suffix:
Authorized Official - Credentials:RVT
Authorized Official - Phone:626-289-2720
Mailing Address - Street 1:1316 STEVENS AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-4477
Mailing Address - Country:US
Mailing Address - Phone:626-818-7226
Mailing Address - Fax:
Practice Address - Street 1:1316 STEVENS AVE
Practice Address - Street 2:UNIT B
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-4477
Practice Address - Country:US
Practice Address - Phone:626-818-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1092782471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty