Healthcare Provider Details

I. General information

NPI: 1699029132
Provider Name (Legal Business Name): AMERICAN ALLIED DIAGNOSTICS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 S CENTRAL AVE
GLENDALE CA
91204-2212
US

IV. Provider business mailing address

6800 LINCOLN AVE STE 100
BUENA PARK CA
90620-4163
US

V. Phone/Fax

Practice location:
  • Phone: 818-244-4646
  • Fax: 818-244-2047
Mailing address:
  • Phone: 714-995-5400
  • Fax: 714-995-5254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License NumberG43636
License Number StateCA

VIII. Authorized Official

Name: SIM C HOFFMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 714-995-5400