SD Xray LLC

Primary specialty

Portable X-ray and/or Other Portable Diagnostic Imaging SupplierTaxonomy code 335V00000X

Legal business name

SD XRAY LLC

Practice address

3220 S Brea Canyon Rd Ste B
Diamond Bar, CA 91765-3481

Phone

(619) 562-6100

NPI assigned

Jun 25, 2019

Last updated

Jun 25, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Beau ChungNPI 1841746799

Title

Medical Director

Phone

(949) 274-8807

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679134118. Details of each certification follow.

• CCN 05X0010003 Portable X-ray supplier · Active · Name & address match · Details

Portable X-ray supplier certification: CCN 05X0010003

Legal name

SD XRAY

Certification status

Active

Provider type (POS)

Portable X-ray supplier

Participating since

Oct 28, 1997

Last certification

Feb 21, 2019

Ownership / control type

Individual

Facility address

8772 Cuyamaca St #102 (RHB 28354)
Santee, CA 92071

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Beau Michael Chung, D.O.

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1841746799
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561420800000",
    "number": "1679134118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3220 S BREA CANYON RD STE B",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917653481",
            "telephone_number": "619-562-6100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3220 S BREA CANYON RD STE B",
            "city": "DIAMOND BAR",
            "state": "CA",
            "postal_code": "917653481",
            "telephone_number": "619-562-6100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8772 Cuyamaca St Ste 102",
            "address_purpose": "LOCATION",
            "city": "Santee",
            "state": "CA",
            "postal_code": "920714207",
            "country_code": "US",
            "telephone_number": "619-562-6100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SD XRAY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-25",
        "last_updated": "2019-06-25",
        "status": "A",
        "authorized_official_last_name": "CHUNG",
        "authorized_official_first_name": "BEAU",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "949-274-8807"
    },
    "taxonomies": [
        {
            "code": "335V00000X",
            "taxonomy_group": "",
            "desc": "Portable X-ray and/or Other Portable Diagnostic Imaging Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in Diamond Bar, CA
• Providers in Diamond Bar, CA by specialty
• Portable X-ray and/or Other Portable Diagnostic Imaging Supplier in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.