Provider Demographics
NPI:1609147552
Name:ROYAL MRI & MEDICAL CENTER INC
Entity Type:Organization
Organization Name:ROYAL MRI & MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HEDAYAT
Authorized Official - Middle Name:ED
Authorized Official - Last Name:GOLCHEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-905-7323
Mailing Address - Street 1:16311 VENTURA BLVD STE 787
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4329
Mailing Address - Country:US
Mailing Address - Phone:818-905-7323
Mailing Address - Fax:818-783-6108
Practice Address - Street 1:16311 VENTURA BLVD STE 787
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4329
Practice Address - Country:US
Practice Address - Phone:818-905-7323
Practice Address - Fax:818-783-6108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-24
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA040588261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)