Provider Demographics
NPI:1215085618
Name:ST FRANCIS RADIOLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:ST FRANCIS RADIOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER IN ST FRANCIS RADIOLOGY MED
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:SZETO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-900-8852
Mailing Address - Street 1:PO BOX 4505
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-4505
Mailing Address - Country:US
Mailing Address - Phone:805-375-8800
Mailing Address - Fax:805-375-8900
Practice Address - Street 1:3630 EAST IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262
Practice Address - Country:US
Practice Address - Phone:310-900-8852
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0017660Medicaid
CAHSC30104FOtherMEDI CAL IP FACILITY ID
CAZZZ90555ZOtherBLUE SHIELD OF CALIFORNIA
CAGR0017660Medicaid