Provider Demographics
NPI:1578527339
Name:PROHEALTH ADVANCED IMAGING INSTITUTE, L.L.C.
Entity Type:Organization
Organization Name:PROHEALTH ADVANCED IMAGING INSTITUTE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KASHFIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-710-6011
Mailing Address - Street 1:7345 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1910
Mailing Address - Country:US
Mailing Address - Phone:818-710-6011
Mailing Address - Fax:818-456-5039
Practice Address - Street 1:7345 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 130
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1910
Practice Address - Country:US
Practice Address - Phone:818-710-6011
Practice Address - Fax:818-456-5039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAIDTF00220Medicaid
CAZZZ02029ZOtherBLUE SHIELD OF CALIF
CAIDTF00220Medicaid