Healthcare Provider Details

I. General information

NPI: 1841441821
Provider Name (Legal Business Name): DAV-KIM PORTABLE X RAY SERVICE CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8235 CHRISTIANA AVE
SKOKIE IL
60076-2910
US

IV. Provider business mailing address

PO BOX 1126
NORTHBROOK IL
60065-1126
US

V. Phone/Fax

Practice location:
  • Phone: 224-337-1000
  • Fax: 224-337-0100
Mailing address:
  • Phone: 224-337-1000
  • Fax: 224-337-0100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: ETAI SOOLIMAN
Title or Position: CEO
Credential:
Phone: 224-337-1000