Provider Demographics
NPI:1699029132
Name:AMERICAN ALLIED DIAGNOSTICS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:AMERICAN ALLIED DIAGNOSTICS MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIM
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-995-5400
Mailing Address - Street 1:6800 LINCOLN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4163
Mailing Address - Country:US
Mailing Address - Phone:714-995-5400
Mailing Address - Fax:714-995-5254
Practice Address - Street 1:1109 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2212
Practice Address - Country:US
Practice Address - Phone:818-244-4646
Practice Address - Fax:818-244-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43636261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology