Provider Demographics
NPI:1952891251
Name:ALL STAR IMAGING
Entity type:Organization
Organization Name:ALL STAR IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSHORYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-649-1801
Mailing Address - Street 1:1451 E CHEVY CHASE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1451 E CHEVY CHASE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206
Practice Address - Country:US
Practice Address - Phone:818-649-1801
Practice Address - Fax:818-649-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology