MEDICARE: CALIFORNIA MEDICAL IMAGING CORP.

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
2	2085B0100X	Body Imaging Physician

General Provider Information

NPI Number	:	1811342439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA MEDICAL IMAGING CORP.

Provider Business Mailing Address
First Line	:	5757 WILSHIRE BLVD STE 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3686
Country	:	US
Telephone Number	:	323-648-0500
Fax Number	:	323-648-0508

Provider Business Practice Location Address
First Line	:	5757 WILSHIRE BLVD STE 100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3686
Country	:	US
Telephone Number	:	323-648-0500
Fax Number	:	323-648-0508

Authorized Official
Title or Position	:	CEO
Name	:	SAMMY CILING
Credential	:
Telephone Number	:	323-648-0500

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	08/18/2020

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