Provider Demographics
NPI:1346811890
Name:MEDICAL IMAGING SPECIALISTS CA INC
Entity type:Organization
Organization Name:MEDICAL IMAGING SPECIALISTS CA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HAITHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHATTAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-929-2883
Mailing Address - Street 1:533 AIRPORT BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-2013
Mailing Address - Country:US
Mailing Address - Phone:708-929-2883
Mailing Address - Fax:
Practice Address - Street 1:533 AIRPORT BLVD STE 400
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-2013
Practice Address - Country:US
Practice Address - Phone:708-929-2883
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty