Provider Demographics
NPI:1649316449
Name:AGM DIAGNOSTICS CENTER INC
Entity type:Organization
Organization Name:AGM DIAGNOSTICS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHSHARUMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-990-0090
Mailing Address - Street 1:14148 MAGNOLIA BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-6413
Mailing Address - Country:US
Mailing Address - Phone:818-990-0090
Mailing Address - Fax:818-990-0439
Practice Address - Street 1:14148 MAGNOLIA BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-6413
Practice Address - Country:US
Practice Address - Phone:818-990-0090
Practice Address - Fax:818-990-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATD091Medicare ID - Type Unspecified
CAY27681Medicare UPIN