Provider Demographics
NPI:1689905564
Name:PREMIER HEALTH SERVICES INC
Entity Type:Organization
Organization Name:PREMIER HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:UEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-302-3402
Mailing Address - Street 1:13659 VICTORY BLVD
Mailing Address - Street 2:STE 690
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1735
Mailing Address - Country:US
Mailing Address - Phone:818-302-3402
Mailing Address - Fax:818-647-0359
Practice Address - Street 1:7136 HASKELL AVE
Practice Address - Street 2:STE 125
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4112
Practice Address - Country:US
Practice Address - Phone:818-302-3402
Practice Address - Fax:818-647-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-17
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA944102085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty