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Provider Information for 1003874702

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

PROHEALTH ADVANCED IMAGING MEDICAL GROUP, INC.

Organization Subpart: NO

Organization NPI: 1003874702

Calendar   Last Updated:  2012-03-27
  Certification Date: 

Details

Name Value
NPI 1003874702
Enumeration Date 2006-05-02
NPI Type 2- Organization
Status Active
Authorized Official Information Name: PAYAM KASHFIAN M.D.
Title: PRESIDENT
Phone: 818-301-6700
Mailing Address 10767 RIVERSIDE DR
NORTH HOLLYWOOD, CA 91602-2324
United States

Phone: 818-301-6700 | Fax: 818-301-6701
View Map External Link
Primary Practice Address 10767 RIVERSIDE DR
NORTH HOLLYWOOD, CA 91602-2324
United States

Phone: 818-301-6700 | Fax: 818-301-6701
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other BLUE SHIELD OF CALIFORNIA CA ZZZ66550Z
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 193400000X SINGLE SPECIALTY GROUP
2085R0202X - Radiology Diagnostic Radiology