Provider Demographics
NPI:1013193309
Name:WILSHIRE RADIOLOGY MRI INC
Entity Type:Organization
Organization Name:WILSHIRE RADIOLOGY MRI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-487-7517
Mailing Address - Street 1:3055 WILSHIRE BLVD
Mailing Address - Street 2:STE.150
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1108
Mailing Address - Country:US
Mailing Address - Phone:213-487-7517
Mailing Address - Fax:
Practice Address - Street 1:3055 WILSHIRE BLVD
Practice Address - Street 2:STE.150
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1108
Practice Address - Country:US
Practice Address - Phone:213-487-7517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID