MEDICARE: EZ DIAGNOSIS CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1225238769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EZ DIAGNOSIS CENTER LLC

Provider Business Mailing Address
First Line	:	520 S VIRGIL AVE STE 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 S VIRGIL AVE STE 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1417
Country	:	US
Telephone Number	:	213-387-2212
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YONG J LEE
Credential	:
Telephone Number	:	818-456-9787

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	10/13/2008

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Directions to “EZ DIAGNOSIS CENTER LLC ” Practice Location

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