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General NPI Number Information
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NPI Number | 1669292405
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Entity Type | Organization
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Legal Business Name | KECK MEDICINE OF USC IMAGING CENTERS, LLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 590 S FAIR OAKS AVE STE 143
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City | PASADENA
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State | CA
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Zip | 91105-2614
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Country | US
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Telephone | 626-517-8676
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Fax | 626-517-8677
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Provider Business Mailing Address
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Address Line | 1510 SAN PABLO ST STE 600
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City | LOS ANGELES
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State | CA
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Zip | 90033-5405
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Country | US
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Telephone | 323-442-8747
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | JEREMY CHURCH
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Credential |
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Telephone | 323-442-8747
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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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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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