Provider Demographics
NPI:1497070692
Name:DIAGNOSTIC OREGON IMAGE INC
Entity Type:Organization
Organization Name:DIAGNOSTIC OREGON IMAGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-550-8006
Mailing Address - Street 1:1441 SE 122ND AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-1270
Mailing Address - Country:US
Mailing Address - Phone:360-550-8006
Mailing Address - Fax:
Practice Address - Street 1:1441 SE 122ND AVE
Practice Address - Street 2:SUITE H
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-1270
Practice Address - Country:US
Practice Address - Phone:360-550-8006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty