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General NPI Number Information
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NPI Number | 1992017057
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Entity Type | Organization
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Legal Business Name | MILLENNIUM DIAGNOSTIC IMAGING SERVICE INC
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 1305 S. COURSON DRIVE
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City | ANAHEIM
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State | CA
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Zip | 92804-4721
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Country | US
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Telephone | 877-277-7848
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Fax | 855-464-4936
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Provider Business Mailing Address
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Address Line | 1305 S COURSON DR
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City | ANAHEIM
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State | CA
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Zip | 92804-4721
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Country | US
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Telephone | 877-277-7848
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Fax | 855-464-4936
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Authorized Official
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Title or Position | CEO
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Name | MR. SUKHPAL SINGH KHUNKHUN
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Credential |
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Telephone | 877-277-7848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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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 | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number |
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License Number State |
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