Multi Diagnostic Imaging and Breast Center Medical Group Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

A29572 Issued in CA

Legal business name

MULTI DIAGNOSTIC IMAGING AND BREAST CENTER MEDICAL GROUP INC.

Practice address

4910 Van Nuys Blvd
110
Sherman Oaks, CA 91403-1782

Phone

(818) 986-8215

Fax

(818) 986-9582

NPI assigned

Oct 17, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Khosrow Sadrieh, M.D.

Title

President

Phone

(818) 986-8215

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1164503371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 VAN NUYS BLVD",
            "address_2": "110",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031782",
            "telephone_number": "818-986-8215",
            "fax_number": "818-986-9582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 VAN NUYS BLVD",
            "address_2": "110",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031782",
            "telephone_number": "818-986-8215",
            "fax_number": "818-986-9582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULTI DIAGNOSTIC IMAGING AND BREAST CENTER MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SADRIEH",
        "authorized_official_first_name": "KHOSROW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-986-8215",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A29572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER NUMB",
            "identifier": "ZZZ48958Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "ZZZ97621Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A295720",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Sherman Oaks, CA
• Providers in Sherman Oaks, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.