Provider Demographics
NPI:1417909714
Name:CARDIO DIAGNOSTIC IMAGING, INC.
Entity Type:Organization
Organization Name:CARDIO DIAGNOSTIC IMAGING, INC.
Other - Org Name:TITAN IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-273-8550
Mailing Address - Street 1:9201 W SUNSET BLVD
Mailing Address - Street 2:SUITE M-150
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3701
Mailing Address - Country:US
Mailing Address - Phone:310-273-8550
Mailing Address - Fax:310-273-8567
Practice Address - Street 1:9201 W SUNSET BLVD
Practice Address - Street 2:SUITE M-150
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3701
Practice Address - Country:US
Practice Address - Phone:310-273-8550
Practice Address - Fax:310-273-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91404Medicare UPIN
CAA245200Medicare UPIN