MEDICARE: KARIN L. FU, M.D., 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
1	261QR0208X	Mobile Radiology Clinic/Center

General Provider Information

NPI Number	:	1164769584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARIN L. FU, M.D., INC.

Provider Business Mailing Address
First Line	:	1016 E BROADWAY STE 103
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-4534
Country	:	US
Telephone Number	:	818-240-8310
Fax Number	:	818-240-8303

Provider Business Practice Location Address
First Line	:	1016 E BROADWAY STE 103
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91205-4534
Country	:	US
Telephone Number	:	818-240-8310
Fax Number	:	818-240-8303

Authorized Official
Title or Position	:	MANAGER
Name	:	TINA KESHISHIAN
Credential	:	ARDMS
Telephone Number	:	818-590-8557

Provider Enumeration Date	:	01/04/2013
Last Update Date	:	06/24/2013

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