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NPI Code Detail

MEDICARE: MAK DIAGNOSTIC SERVICES, INC.

MEDICARE: MAK DIAGNOSTIC SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician
2261QR0208XMobile Radiology Clinic/Center
3293D00000XPhysiological Laboratory
4261QR0200XRadiology Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1ZZZ44102ZOTHERCAB/S ROVIDER NUMBER

General Provider Information

NPI Number : 1093799108
Entity Type Code : Organization
Provider Name (Legal Business Name) : MAK DIAGNOSTIC SERVICES, INC.
Provider Business Mailing Address
First Line : 8306 WILSHIRE BLVD
Second Line : STE 210
City : BEVERLY HILLS
State : CA
Zip : 90211-2382
Country : US
Telephone Number : 310-289-0217
Fax Number : 310-289-0372
Provider Business Practice Location Address
First Line : 292 S LA CIENEGA BLVD
Second Line : STE 202
City : BEVERLY HILLS
State : CA
Zip : 90211-3330
Country : US
Telephone Number : 310-289-0217
Fax Number : 310-289-0372
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. BORIS GERZENSHTEIN
Credential :
Telephone Number : 310-289-0217
Provider Enumeration Date : 12/01/2005
Last Update Date : 06/11/2020

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Directions to “MAK DIAGNOSTIC SERVICES, INC. ” Practice Location

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