=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265637961
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR DIAGNOSTIC IMAGING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6200 WILSHIRE BLVD 101
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-933-1112
-----------------------------------------------------
Fax | 323-933-9994
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6200 WILSHIRE BLVD 101
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-5801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-933-1112
-----------------------------------------------------
Fax | 323-933-9994
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PATNER
-----------------------------------------------------
Name | ALI JANJUA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-933-1112
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------