=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578527339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROHEALTH ADVANCED IMAGING INSTITUTE, L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2006
-----------------------------------------------------
Last Update Date | 01/27/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7345 MEDICAL CENTER DR SUITE 130
-----------------------------------------------------
City | WEST HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91307-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-710-6011
-----------------------------------------------------
Fax | 818-456-5039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7345 MEDICAL CENTER DR SUITE 130
-----------------------------------------------------
City | WEST HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91307-1910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-710-6011
-----------------------------------------------------
Fax | 818-456-5039
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PAYAM KASHFIAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-710-6011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------