Provider Demographics
NPI:1568906964
Name:710 IMAGING INC
Entity Type:Organization
Organization Name:710 IMAGING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-247-0160
Mailing Address - Street 1:710 S CENTRAL AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4609
Mailing Address - Country:US
Mailing Address - Phone:818-247-3905
Mailing Address - Fax:818-247-3904
Practice Address - Street 1:710 S CENTRAL AVE
Practice Address - Street 2:SUITE 220 & 230
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4609
Practice Address - Country:US
Practice Address - Phone:323-644-9504
Practice Address - Fax:323-644-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34051261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88017Medicare UPIN