Healthcare Provider Details

I. General information

NPI: 1568751204
Provider Name (Legal Business Name): RJ ULTRASOUND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 05/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14650 ROSCOE BLVD SUITE 7
PANORAMA CITY CA
91402-4149
US

IV. Provider business mailing address

14650 ROSCOE BLVD SUITE 7
PANORAMA CITY CA
91402-4149
US

V. Phone/Fax

Practice location:
  • Phone: 818-855-1450
  • Fax: 818-855-1451
Mailing address:
  • Phone: 818-855-1450
  • Fax: 818-855-1451

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 Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JIMMY K CHANBONPIN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 818-895-3535