MEDICARE: ULTRASCAN 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
1	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1891895884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ULTRASCAN SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 93215
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90093-0215
Country	:	US
Telephone Number	:	323-954-8131
Fax Number	:	323-954-8127

Provider Business Practice Location Address
First Line	:	6210 WILSHIRE BLVD
Second Line	:	SUITE #201
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5105
Country	:	US
Telephone Number	:	323-954-8131
Fax Number	:	323-954-8127

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ARTHUR KHACHATURYAN
Credential	:	RDMS, RVT
Telephone Number	:	323-954-8131

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/22/2020

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