Provider Demographics
NPI:1144391947
Name:IPB MEDICAL DIAGNOSTIC, INC.
Entity Type:Organization
Organization Name:IPB MEDICAL DIAGNOSTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAVEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIMKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-500-6410
Mailing Address - Street 1:PO BOX 9155
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90295-1555
Mailing Address - Country:US
Mailing Address - Phone:310-500-6410
Mailing Address - Fax:
Practice Address - Street 1:8939 S SEPULVEDA BL
Practice Address - Street 2:SUITE 504
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3631
Practice Address - Country:US
Practice Address - Phone:310-649-5264
Practice Address - Fax:310-822-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory