Healthcare Provider Details

I. General information

NPI: 1013960681
Provider Name (Legal Business Name): K & T DIAGNOSTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 HAYVENHURST AVE SUITE 407
VAN NUYS CA
91406-3813
US

IV. Provider business mailing address

7120 HAYVENHURST AVE SUITE 407
VAN NUYS CA
91406-3813
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-3217
  • Fax: 818-787-0858
Mailing address:
  • Phone: 818-787-3217
  • Fax: 818-787-0858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VLADISLAV KOKHAN
Title or Position: CEO
Credential:
Phone: 818-787-3217