Healthcare Provider Details

I. General information

NPI: 1346811890
Provider Name (Legal Business Name): MEDICAL IMAGING SPECIALISTS CA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 AIRPORT BLVD STE 400
BURLINGAME CA
94010-2013
US

IV. Provider business mailing address

533 AIRPORT BLVD STE 400
BURLINGAME CA
94010-2013
US

V. Phone/Fax

Practice location:
  • Phone: 708-929-2883
  • Fax:
Mailing address:
  • Phone: 708-929-2883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: HAITHAM KHATTAB
Title or Position: CEO
Credential:
Phone: 708-929-2883