Provider Demographics
NPI:1710298765
Name:SPECTRUM ADVANCED RADIOLOGY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SPECTRUM ADVANCED RADIOLOGY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VU
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-280-0431
Mailing Address - Street 1:8338 VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1636
Mailing Address - Country:US
Mailing Address - Phone:626-280-0431
Mailing Address - Fax:626-280-6840
Practice Address - Street 1:8338 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1636
Practice Address - Country:US
Practice Address - Phone:626-280-0431
Practice Address - Fax:626-280-6840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty