Mikwaves Diagnostic Inc

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

0002055859-0001-1 Issued in CA

Legal business name

MIKWAVES DIAGNOSTIC INC

Practice address

11120 Burbank Blvd
Space 1a
North Hollywood, CA 91601-5708

Phone

(818) 509-8808

Fax

(818) 509-8806

NPI assigned

Feb 13, 2007

Organization subpart

No

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

Authorized official

Name

Michael Ridjan

Title

Director

Phone

(818) 509-8808

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1285776237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11120 BURBANK BLVD",
            "address_2": "SPACE 1A",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916015708",
            "telephone_number": "818-509-8808",
            "fax_number": "818-509-8806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11120 BURBANK BLVD",
            "address_2": "SPACE 1A",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916015708",
            "telephone_number": "818-509-8808",
            "fax_number": "818-509-8806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIKWAVES DIAGNOSTIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RIDJAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "818-509-8808"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "0002055859-0001-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Multi-Specialty Clinic/Center in North Hollywood, CA
• Providers in North Hollywood, CA by specialty
• Multi-Specialty Clinic/Center 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.