Provider Demographics
NPI:1407963275
Name:PACIFIC MEDICAL IMAGING AND ONCOLOGY CENTER, INC
Entity Type:Organization
Organization Name:PACIFIC MEDICAL IMAGING AND ONCOLOGY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-227-2727
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93062-0065
Mailing Address - Country:US
Mailing Address - Phone:805-577-8730
Mailing Address - Fax:805-991-4065
Practice Address - Street 1:707 S GARFIELD AVE
Practice Address - Street 2:SUITE B-001
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5859
Practice Address - Country:US
Practice Address - Phone:626-227-2727
Practice Address - Fax:626-227-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC2578418261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0101900Medicaid
CAW19267Medicare PIN