MEDICARE: PRIME RAD INC

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	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1972323228
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME RAD INC

Provider Business Mailing Address
First Line	:	1400 S SAN GABRIEL BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3603
Country	:	US
Telephone Number	:	626-464-4314
Fax Number	:	626-603-6994

Provider Business Practice Location Address
First Line	:	1400 S SAN GABRIEL BLVD
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3603
Country	:	US
Telephone Number	:	626-464-4314
Fax Number	:	626-603-6994

Authorized Official
Title or Position	:	SUPERVISING RADIOLOGIST/OWNER
Name	:	DR. HUY Q LE
Credential	:	MD/PHD
Telephone Number	:	714-398-2287

Provider Enumeration Date	:	10/11/2024
Last Update Date	:	10/11/2024

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