Provider Demographics
NPI:1447585070
Name:MEDX DIAGNOSTICS INC
Entity Type:Organization
Organization Name:MEDX DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHILIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-247-2660
Mailing Address - Street 1:540 N CENTRAL AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1916
Mailing Address - Country:US
Mailing Address - Phone:818-247-2660
Mailing Address - Fax:818-244-9946
Practice Address - Street 1:540 N CENTRAL AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1916
Practice Address - Country:US
Practice Address - Phone:818-247-2660
Practice Address - Fax:818-244-9946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084N0400X
G352452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty