Healthcare Provider Details

I. General information

NPI: 1871861591
Provider Name (Legal Business Name): OMNI IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2011
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 BROADWAY
EVERETT WA
98201-4472
US

IV. Provider business mailing address

3331 BROADWAY
EVERETT WA
98201-4472
US

V. Phone/Fax

Practice location:
  • Phone: 425-259-7900
  • Fax: 425-252-0993
Mailing address:
  • Phone: 425-259-7900
  • Fax: 425-252-0993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number603126999
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number603126999
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number603126999
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number603126999
License Number StateWA

VIII. Authorized Official

Name: MR. KEYVAN YOUSEFIAN
Title or Position: CEO
Credential:
Phone: 425-259-7900