Provider Demographics
NPI:1942713482
Name:BEVERLY HILLS MEDICAL IMAGING
Entity Type:Organization
Organization Name:BEVERLY HILLS MEDICAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PUNEET
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHANDAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-953-4099
Mailing Address - Street 1:39120 ARGONAUT WAY
Mailing Address - Street 2:BOX 827
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1304
Mailing Address - Country:US
Mailing Address - Phone:510-792-9700
Mailing Address - Fax:510-792-9701
Practice Address - Street 1:50 N LA CIENEGA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:510-953-4099
Practice Address - Fax:510-792-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty