Provider Demographics
NPI:1831402973
Name:MILLENIUM DIAGNOSTIC IMAGING SERVICES
Entity type:Organization
Organization Name:MILLENIUM DIAGNOSTIC IMAGING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SUKHPAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHUNKHUN
Authorized Official - Suffix:
Authorized Official - Credentials:RDCS
Authorized Official - Phone:714-995-2168
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:714-995-2168
Mailing Address - Fax:
Practice Address - Street 1:1305 S COURSON DR
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:714-995-2168
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92703 RDCS261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile