Provider Demographics
NPI:1396791497
Name:LYNWOOD MEDICAL IMAGING LLC
Entity type:Organization
Organization Name:LYNWOOD MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SEPEHR
Authorized Official - Middle Name:
Authorized Official - Last Name:KATIRAIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-588-3800
Mailing Address - Street 1:2638 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:WALNUT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4708
Mailing Address - Country:US
Mailing Address - Phone:323-588-3800
Mailing Address - Fax:323-277-0399
Practice Address - Street 1:2638 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:WALNUT PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4708
Practice Address - Country:US
Practice Address - Phone:323-588-3800
Practice Address - Fax:323-277-0399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiologyGroup - Single Specialty