MEDICARE: VA GREATER LOS ANGELES NUCLEAR MEDICINE DEPARTMENT

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	286500000X	Military Hospital

General Provider Information

NPI Number	:	1962789230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VA GREATER LOS ANGELES NUCLEAR MEDICINE DEPARTMENT

Provider Business Mailing Address
First Line	:	11301 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90073-1003
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90073-1003
Country	:	US
Telephone Number	:	310-478-3711
Fax Number	:

Authorized Official
Title or Position	:	RESIDENT PHYSICIAN
Name	:	CHIAYI NI
Credential	:	MD
Telephone Number	:	310-478-3711

Provider Enumeration Date	:	11/14/2011
Last Update Date	:	11/21/2013

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