Provider Demographics
NPI:1295712339
Name:US TECH DIAGNOSTIC INC
Entity type:Organization
Organization Name:US TECH DIAGNOSTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALASHNIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-789-4170
Mailing Address - Street 1:17071 VENTURA BLVD
Mailing Address - Street 2:#225
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-4130
Mailing Address - Country:US
Mailing Address - Phone:818-789-4170
Mailing Address - Fax:818-789-4177
Practice Address - Street 1:14426 GILMORE ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1429
Practice Address - Country:US
Practice Address - Phone:818-908-0551
Practice Address - Fax:818-908-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y31093Medicare UPIN