Southern California Medical Diagnostics Group, Inc.

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

G43636A Issued in CA

Legal business name

SOUTHERN CALIFORNIA MEDICAL DIAGNOSTICS GROUP, INC.

Practice address

1109 S Central Ave
Glendale, CA 91204-2212

Phone

(213) 484-0004

Fax

(213) 484-0088

NPI assigned

Aug 19, 2010

Organization subpart

No

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

Authorized official

Name

Sim C Hoffman, M.D.

Title

President/Owner

Phone

(714) 995-5400

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1282176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384300800000",
    "number": "1083920607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10094",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912093094",
            "telephone_number": "818-244-4646",
            "fax_number": "818-244-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 S CENTRAL AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042212",
            "telephone_number": "213-484-0004",
            "fax_number": "213-484-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA MEDICAL DIAGNOSTICS GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-19",
        "last_updated": "2013-11-13",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "SIM",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "714-995-5400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "CA",
            "license": "G43636A",
            "primary": true
        },
        {
            "code": "261QS1200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Sleep Disorder Diagnostic",
            "state": "CA",
            "license": "G43636A",
            "primary": false
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Radiology Clinic/Center in Glendale, CA
• Providers in Glendale, CA by specialty
• Radiology Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; 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.