NPIMap

Organization Active NPI

Innovative Diagnostic Medical Group

  • Physiological Laboratory
  • Los Angeles, CA
National Provider Identifier
1013131796
Registry record updated Dec 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physiological LaboratoryTaxonomy code 293D00000X
License
A44107 Issued in CA
Legal business name
INNOVATIVE DIAGNOSTIC MEDICAL GROUP
Practice address
1801 Century Park East
Suite 1040
Los Angeles, CA 90067
Phone
(310) 553-7980
Fax
(310) 943-3279
NPI assigned
Apr 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sean Ataee, M.D.
Title
Medical Director/Owner
Phone
(310) 553-7960

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208100000X A106704 CA
Physiological Laboratory 293D00000X A44107 CA Primary

Addresses

Primary practice location

1801 Century Park East
Suite 1040
Los Angeles, CA 90067

Mailing address

1801 Century Park East
Suite 1040
Los Angeles, CA 90067
Phone (310) 553-7980

National Provider Directory

National Provider Directory

Locations

1801 Century Park E
Ste 1040
Los Angeles, CA 90067
Phone (310) 553-7980

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292457600000",
    "number": "1013131796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 CENTURY PARK EAST",
            "address_2": "SUITE 1040",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90067",
            "telephone_number": "310-553-7980",
            "fax_number": "310-943-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 CENTURY PARK EAST",
            "address_2": "SUITE 1040",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90067",
            "telephone_number": "310-553-7980",
            "fax_number": "310-943-3279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE DIAGNOSTIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2010-12-16",
        "status": "A",
        "authorized_official_last_name": "ATAEE",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "310-553-7960",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "A106704",
            "primary": false
        },
        {
            "code": "293D00000X",
            "taxonomy_group": "",
            "desc": "Physiological Laboratory",
            "state": "CA",
            "license": "A44107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.