Healthcare Provider Details

I. General information

NPI: 1811342439
Provider Name (Legal Business Name): CALIFORNIA MEDICAL IMAGING CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WILSHIRE BLVD STE 100
LOS ANGELES CA
90036-3686
US

IV. Provider business mailing address

5757 WILSHIRE BLVD STE 100
LOS ANGELES CA
90036-3686
US

V. Phone/Fax

Practice location:
  • Phone: 323-648-0500
  • Fax: 323-648-0508
Mailing address:
  • Phone: 323-648-0500
  • Fax: 323-648-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SAMMY CILING
Title or Position: CEO
Credential:
Phone: 323-648-0500