Healthcare Provider Details

I. General information

NPI: 1699279588
Provider Name (Legal Business Name): U.S. DIAGNOSTIC MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 W BURBANK BLVD STE 202
BURBANK CA
91505-2300
US

IV. Provider business mailing address

2829 W BURBANK BLVD STE 202
BURBANK CA
91505-2300
US

V. Phone/Fax

Practice location:
  • Phone: 747-477-1064
  • Fax:
Mailing address:
  • Phone: 747-477-1064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HENRY OKONKWO
Title or Position: CEO
Credential:
Phone: 424-866-9046