NPIMap

Organization Active NPI

Medizen Magnolia, LLC

  • Diagnostic Radiology Physician
  • Fountain Valley, CA
National Provider Identifier
1700235215
Registry record updated Jun 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
MEDIZEN MAGNOLIA, LLC
Practice address
17305 Brookhurst St
Fountain Valley, CA 92708-3721
Phone
(714) 968-8998
Fax
(714) 968-8628
NPI assigned
Jun 6, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2016

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

Authorized official

Name
Dr. David T Mai, M.D.
Title
President
Phone
(714) 968-8998

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Body Imaging PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085B0100X CA
Nuclear Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085N0904X CA
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X CA Primary
Diagnostic Ultrasound PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085U0001X CA
Radiology Clinic/Center 261QR0200X CA

Addresses

Primary practice location

17305 Brookhurst St
Fountain Valley, CA 92708-3721

Mailing address

17305 Brookhurst St
Fountain Valley, CA 92708-3721
Phone (714) 968-8998

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1465171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465171200000",
    "number": "1700235215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17305 BROOKHURST ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083721",
            "telephone_number": "714-968-8998",
            "fax_number": "714-968-8628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17305 BROOKHURST ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083721",
            "telephone_number": "714-968-8998",
            "fax_number": "714-968-8628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDIZEN MAGNOLIA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-06",
        "last_updated": "2016-06-06",
        "status": "A",
        "authorized_official_last_name": "MAI",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-968-8998",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085B0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "2085N0904X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2016; 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.