Healthcare Provider Details

I. General information

NPI: 1841432994
Provider Name (Legal Business Name): DYNAMIC DIAGNOSTIC IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14532 FRIAR ST STE D
VAN NUYS CA
91411-4715
US

IV. Provider business mailing address

PO BOX 19333
ENCINO CA
91416-9333
US

V. Phone/Fax

Practice location:
  • Phone: 818-909-9696
  • Fax:
Mailing address:
  • Phone: 818-909-9696
  • Fax:

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: SHAHRIAR S. RAD
Title or Position: PRESIDENT
Credential: DC
Phone: 818-909-9696