Healthcare Provider Details

I. General information

NPI: 1538264288
Provider Name (Legal Business Name): HILL STREET IMAGING MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N. HILL STREET
LOS ANGELES CA
90012
US

IV. Provider business mailing address

824 N HILL ST
LOS ANGELES CA
90012-2321
US

V. Phone/Fax

Practice location:
  • Phone: 213-626-7816
  • Fax:
Mailing address:
  • Phone: 626-821-1411
  • Fax: 626-821-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA38858
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA38858
License Number StateCA

VIII. Authorized Official

Name: WILLIAM C. CHU
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 213-626-7816