Provider Demographics
NPI:1124190145
Name:ADVANCED HEART MONITORING
Entity Type:Organization
Organization Name:ADVANCED HEART MONITORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIANPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-474-6541
Mailing Address - Street 1:2355 WESTWOOD BLVD.
Mailing Address - Street 2:321
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2109
Mailing Address - Country:US
Mailing Address - Phone:310-474-6541
Mailing Address - Fax:310-470-9779
Practice Address - Street 1:10757 CLARKSON RD.
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2109
Practice Address - Country:US
Practice Address - Phone:310-474-6541
Practice Address - Fax:310-470-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TG611OtherMEDICARE PROVIDER #