Provider Demographics
NPI:1992017057
Name:MILLENNIUM DIAGNOSTIC IMAGING SERVICE INC
Entity Type:Organization
Organization Name:MILLENNIUM DIAGNOSTIC IMAGING SERVICE INC
Other - Org Name:MDIS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SUKHPAL
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:KHUNKHUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-277-7848
Mailing Address - Street 1:1305 S COURSON DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4721
Mailing Address - Country:US
Mailing Address - Phone:877-277-7848
Mailing Address - Fax:855-464-4936
Practice Address - Street 1:1305 S. COURSON DRIVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4721
Practice Address - Country:US
Practice Address - Phone:877-277-7848
Practice Address - Fax:855-464-4936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty