Provider Demographics
NPI:1144879198
Name:SOUTHERN CALIFORNIA MEDICAL IMAGING AND OPEN MRI
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA MEDICAL IMAGING AND OPEN MRI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOBAK
Authorized Official - Middle Name:
Authorized Official - Last Name:KARDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-854-4890
Mailing Address - Street 1:4138 ELLENITA AVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-5418
Mailing Address - Country:US
Mailing Address - Phone:818-518-4606
Mailing Address - Fax:
Practice Address - Street 1:1809 VERDUGO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1402
Practice Address - Country:US
Practice Address - Phone:818-790-9300
Practice Address - Fax:818-790-4564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)