Provider Demographics
NPI:1669831459
Name:INSTITUTE OF DIAGNOSITC MEDICINE & RESEARCH INC
Entity Type:Organization
Organization Name:INSTITUTE OF DIAGNOSITC MEDICINE & RESEARCH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KHASHAYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:POURMAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-592-5067
Mailing Address - Street 1:833 S LOS ROBLES AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-3716
Mailing Address - Country:US
Mailing Address - Phone:310-592-5067
Mailing Address - Fax:714-996-9267
Practice Address - Street 1:833 S LOS ROBLES AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-3716
Practice Address - Country:US
Practice Address - Phone:310-592-5067
Practice Address - Fax:714-996-9267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1225092190OtherINDIV NPI