Basic Information
| Provider Information | |||||||||
| NPI: | 1144480773 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VALLEY CENTRAL IMAGING INC | ||||||||
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| OtherOrganizationName: | VALLEY CENTRAL IMAGING MEDICAL CORPORATION | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT LA 21620 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911850001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667522080 | ||||||||
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| Practice Location | |||||||||
| Address1: | 450 GREENFIELD AVE | ||||||||
| Address2: | DEPARTMENT OF RADIOLOGY | ||||||||
| City: | HANFORD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932303513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5595829000 | ||||||||
| FaxNumber: | 5595855230 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2008 | ||||||||
| LastUpdateDate: | 06/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | KOOCHEK | ||||||||
| AuthorizedOfficialFirstName: | KAMRAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7602652434 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0904X | CA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.