San Gabriel Valley Diagnostic Center Medical Group

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

Legal business name

SAN GABRIEL VALLEY DIAGNOSTIC CENTER MEDICAL GROUP

Practice address

1509 W Cameron Ave
Suite D
West Covina, CA 91790-2725

Phone

(626) 962-3525

Fax

(626) 962-0032

NPI assigned

Jun 7, 2006

Organization subpart

No

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

Authorized official

Name

Bharath Kumar Krishnasamy, M.D.

Title

Medical Director

Phone

(626) 962-3525

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306281600000",
    "number": "1790725141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 W CAMERON AVE",
            "address_2": "SUITE D",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902725",
            "telephone_number": "626-962-3525",
            "fax_number": "626-962-0032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 W CAMERON AVE",
            "address_2": "SUITE D",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917902725",
            "telephone_number": "626-962-3525",
            "fax_number": "626-962-0032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN GABRIEL VALLEY DIAGNOSTIC CENTER MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2011-05-25",
        "status": "A",
        "authorized_official_last_name": "KRISHNASAMY",
        "authorized_official_first_name": "BHARATH",
        "authorized_official_middle_name": "KUMAR",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "626-962-3525",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085N0904X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Nuclear Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIF",
            "identifier": "ZZZ11986Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0023300",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• San Gabriel Valley Perinatal Medical Group, Inc

• Diagnostic Radiology Physician in West Covina, CA
• Providers in West Covina, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2011; 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.