Provider Demographics
NPI:1003874702
Name:PROHEALTH ADVANCED IMAGING MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PROHEALTH ADVANCED IMAGING MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-301-6700
Mailing Address - Street 1:10767 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2324
Mailing Address - Country:US
Mailing Address - Phone:818-301-6700
Mailing Address - Fax:818-301-6701
Practice Address - Street 1:10767 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2324
Practice Address - Country:US
Practice Address - Phone:818-301-6700
Practice Address - Fax:818-301-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ66550ZOtherBLUE SHIELD OF CALIFORNIA
CAW19674Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER