Healthcare Provider Details

I. General information

NPI: 1033802913
Provider Name (Legal Business Name): SONO CENTER MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 05/29/2023
Certification Date: 05/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST STE 166
PASADENA CA
91106-2421
US

IV. Provider business mailing address

960 E GREEN ST STE 166
PASADENA CA
91106-2421
US

V. Phone/Fax

Practice location:
  • Phone: 626-381-9430
  • Fax: 626-628-3617
Mailing address:
  • Phone: 626-381-9430
  • Fax: 626-628-3617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. EDMOND KALANTAR OHANIAN
Title or Position: PRESIDENT
Credential: DO
Phone: 818-419-4321