Provider Demographics
NPI:1487661427
Name:INNOVATIVE DIAGNOSTIC IMAGING SERVICES INC
Entity Type:Organization
Organization Name:INNOVATIVE DIAGNOSTIC IMAGING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-705-0548
Mailing Address - Street 1:18905 SHERMAN WAY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335
Mailing Address - Country:US
Mailing Address - Phone:818-705-0548
Mailing Address - Fax:818-705-0579
Practice Address - Street 1:18905 SHERMAN WAY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335
Practice Address - Country:US
Practice Address - Phone:818-705-0548
Practice Address - Fax:818-705-0579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty