=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033802913
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SONO CENTER MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2023
-----------------------------------------------------
Last Update Date | 05/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 960 E GREEN ST STE 166
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91106-2421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-381-9430
-----------------------------------------------------
Fax | 626-628-3617
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 960 E GREEN ST STE 166
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91106-2421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-381-9430
-----------------------------------------------------
Fax | 626-628-3617
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EDMOND KALANTAR OHANIAN
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 818-419-4321
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------