Provider Demographics
NPI:1740384015
Name:DIAGNOSTIC IMAGING NETWORK MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:DIAGNOSTIC IMAGING NETWORK MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
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 1:165 W HOSPITALITY LN
Mailing Address - Street 2:SUITE 27
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3334
Mailing Address - Country:US
Mailing Address - Phone:888-346-3811
Mailing Address - Fax:714-947-1277
Practice Address - Street 1:165 W HOSPITALITY LN
Practice Address - Street 2:SUITE 27
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3334
Practice Address - Country:US
Practice Address - Phone:888-346-3811
Practice Address - Fax:714-947-1277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43636261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0084600Medicaid
CAGR0084600Medicaid