=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538602008
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | US HEALTH IMAGING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2016
-----------------------------------------------------
Last Update Date | 11/30/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8053 E BLOOMINGTON FWY SUITE 450
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55420-4577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-793-3075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16526 YUCCA CIR
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-2251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-793-3075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | KHANH VO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-793-3075
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------