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General NPI Number Information
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NPI Number | 1598711046
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Entity Type | Organization
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Legal Business Name | PROF.IMAGING GRPOUP, INC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9914 SAN JUAN AVE
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City | SOUTH GATE
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State | CA
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Zip | 90280-6108
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Country | US
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Telephone | 323-569-6979
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Fax | 323-249-4626
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Provider Business Mailing Address
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Address Line | 3540 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90010-2316
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Country | US
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Telephone | 213-386-2942
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Fax | 213-386-2942
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Authorized Official
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Title or Position | MANAGER
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Name | MR. VADIM DANIELIAN
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Credential |
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Telephone | 323-821-7772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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