Provider Demographics
NPI:1679689244
Name:OAKS DIAGNOSTIC INC
Entity Type:Organization
Organization Name:OAKS DIAGNOSTIC INC
Other - Org Name:ADVANCED RADIOLOGTY OF BEVERLY HILLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:SELWYN
Authorized Official - Last Name:GRUSD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-289-8678
Mailing Address - Street 1:8641 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2900
Mailing Address - Country:US
Mailing Address - Phone:310-289-8678
Mailing Address - Fax:310-289-1161
Practice Address - Street 1:8641 WILSHIRE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2900
Practice Address - Country:US
Practice Address - Phone:310-289-8678
Practice Address - Fax:310-289-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A327072OtherMEDICAL
CAA32707Medicare ID - Type Unspecified
CAW17217Medicare UPIN
CA00A327072OtherMEDICAL
CATP022Medicare ID - Type Unspecified
CAZZZ01724ZMedicare PIN