Southern California Diagnostic Imaging, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

24687 Issued in CA

Legal business name

SOUTHERN CALIFORNIA DIAGNOSTIC IMAGING, INC.

Practice address

408 S. Beach Blvd.
Suite 106
Anaheim, CA 92804-1873

Phone

(714) 995-5471

Fax

(714) 995-5815

NPI assigned

Apr 17, 2007

Organization subpart

No

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

Authorized official

Name

Steven Chao, M.D.

Title

President

Phone

(714) 995-5471

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Tan Tran M.D., Inc. Former legal business name

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240358400000",
    "number": "1245455773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "408 S. BEACH BLVD.",
            "address_2": "SUITE 106",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928041873",
            "telephone_number": "714-995-5471",
            "fax_number": "714-995-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 S. BEACH BLVD.",
            "address_2": "SUITE 106",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928041873",
            "telephone_number": "714-995-5471",
            "fax_number": "714-995-5815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA DIAGNOSTIC IMAGING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2009-04-22",
        "status": "A",
        "authorized_official_last_name": "CHAO",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-995-5471",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "24687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0964335",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tan Tran M.D., Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Clinic/Center in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2009; 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.