Provider Demographics
NPI:1275699019
Name:DEFINED IMAGING, INC., A PROFESSIONAL MEDICAL GROUP
Entity Type:Organization
Organization Name:DEFINED IMAGING, INC., A PROFESSIONAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-841-7800
Mailing Address - Street 1:PO BOX 90125
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-0125
Mailing Address - Country:US
Mailing Address - Phone:800-404-2353
Mailing Address - Fax:562-795-0676
Practice Address - Street 1:18377 BEACH BLVD
Practice Address - Street 2:SUITE 326
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1381
Practice Address - Country:US
Practice Address - Phone:714-841-7800
Practice Address - Fax:714-841-7806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Multi-Specialty