=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770810541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISCAN MEDICAL IMAGING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2009
-----------------------------------------------------
Last Update Date | 03/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21822 SHERMAN WAY SUITE 201
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-1942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-610-7100
-----------------------------------------------------
Fax | 888-508-3435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21822 SHERMAN WAY SUITE 201
-----------------------------------------------------
City | CANOGA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91303-1942
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-610-7100
-----------------------------------------------------
Fax | 888-508-3435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. TATUL DADURYAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-610-7100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085U0001X
-----------------------------------------------------
Taxonomy Name | Diagnostic Ultrasound Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------