Provider Demographics
NPI:1134343700
Name:IMAGING CENTERS OF ANAHEIM
Entity type:Organization
Organization Name:IMAGING CENTERS OF ANAHEIM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-995-5471
Mailing Address - Street 1:408 S BEACH BLVD STE 106
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-1873
Mailing Address - Country:US
Mailing Address - Phone:714-995-5471
Mailing Address - Fax:714-995-5815
Practice Address - Street 1:408 S BEACH BLVD STE 106
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1873
Practice Address - Country:US
Practice Address - Phone:714-995-5471
Practice Address - Fax:714-995-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG7901174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG79010Medicare UPIN
CAG79012Medicare UPIN
CAG79011Medicare UPIN