Provider Demographics
NPI:1568751204
Name:RJ ULTRASOUND, INC.
Entity Type:Organization
Organization Name:RJ ULTRASOUND, INC.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHANBONPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-895-3535
Mailing Address - Street 1:14650 ROSCOE BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-4149
Mailing Address - Country:US
Mailing Address - Phone:818-855-1450
Mailing Address - Fax:818-855-1451
Practice Address - Street 1:14650 ROSCOE BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-4149
Practice Address - Country:US
Practice Address - Phone:818-855-1450
Practice Address - Fax:818-855-1451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-04
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1568751204Medicare UPIN