=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831460542
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FUTURE DIAGNOSTIC IMAGING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2012
-----------------------------------------------------
Last Update Date | 01/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7901 OAKPORT ST SUITE 2700
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94621-2015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-562-1440
-----------------------------------------------------
Fax | 510-562-1464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7901 OAKPORT ST SUITE 2700
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94621-2015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-562-1440
-----------------------------------------------------
Fax | 510-562-1464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MR. KHOI LAM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-351-5115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0200X
-----------------------------------------------------
Taxonomy Name | Radiology Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------