Healthcare Provider Details

I. General information

NPI: 1902012040
Provider Name (Legal Business Name): AMERICAN INSTITUTE OF MUSCULOSKELETAL DIAGNOSTIC ULTRASOUND (AIMDUS)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 BROADWAY
SANTA MONICA CA
90404-2711
US

IV. Provider business mailing address

1441 BROADWAY
SANTA MONICA CA
60404-2710
US

V. Phone/Fax

Practice location:
  • Phone: 310-456-6182
  • Fax: 310-456-9092
Mailing address:
  • Phone: 310-456-6182
  • Fax: 310-456-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC14105
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberG35245
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ALEX KALIAKIN
Title or Position: OWNER
Credential: D.C.
Phone: 310-456-6182