Provider Demographics
NPI:1235261017
Name:J. T. IMAGING
Entity Type:Organization
Organization Name:J. T. IMAGING
Other - Org Name:MAGED TAWADROS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGED
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWADROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-483-2632
Mailing Address - Street 1:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-1183
Mailing Address - Country:US
Mailing Address - Phone:626-483-2632
Mailing Address - Fax:909-444-0108
Practice Address - Street 1:281 N ALTADENA DR # F
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3364
Practice Address - Country:US
Practice Address - Phone:626-483-2632
Practice Address - Fax:909-444-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAX0010016335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR0510016Medicare PIN
CAR0510016Medicare ID - Type Unspecified
CATG143Medicare ID - Type Unspecified