Provider Demographics
NPI:1659719532
Name:PHOENIX SONOGRAPHIC IMAGING
Entity Type:Organization
Organization Name:PHOENIX SONOGRAPHIC IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROFESSIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-790-2775
Mailing Address - Street 1:207 W CLARENDON AVE
Mailing Address - Street 2:# 10G
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3435
Mailing Address - Country:US
Mailing Address - Phone:718-790-2775
Mailing Address - Fax:
Practice Address - Street 1:207 W CLARENDON AVE
Practice Address - Street 2:# 10G
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3416
Practice Address - Country:US
Practice Address - Phone:718-790-2775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
990182471S1302X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Single Specialty