Healthcare Provider Details

I. General information

NPI: 1396791497
Provider Name (Legal Business Name): LYNWOOD MEDICAL IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2638 E FLORENCE AVE
WALNUT PARK CA
90255-4708
US

IV. Provider business mailing address

2638 E FLORENCE AVE
WALNUT PARK CA
90255-4708
US

V. Phone/Fax

Practice location:
  • Phone: 323-588-3800
  • Fax: 323-277-0399
Mailing address:
  • Phone: 323-588-3800
  • Fax: 323-277-0399

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. SEPEHR KATIRAIE
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 323-588-3800