Provider Demographics
NPI:1417078338
Name:DYNAMIC IMAGING CENTERS LLC
Entity Type:Organization
Organization Name:DYNAMIC IMAGING CENTERS LLC
Other - Org Name:DYNAMIC MRI CENTER OF TACOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-476-9900
Mailing Address - Street 1:5038 TACOMA MALL BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7140
Mailing Address - Country:US
Mailing Address - Phone:253-476-9900
Mailing Address - Fax:253-476-0148
Practice Address - Street 1:5038 TACOMA MALL BLVD STE C
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7140
Practice Address - Country:US
Practice Address - Phone:253-476-9900
Practice Address - Fax:253-476-0148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602-642-028247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8867684Medicare PIN