Provider Demographics
NPI:1972323228
Name:PRIME RAD INC
Entity type:Organization
Organization Name:PRIME RAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISING RADIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HUY
Authorized Official - Middle Name:Q
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD/PHD
Authorized Official - Phone:714-398-2287
Mailing Address - Street 1:1400 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3603
Mailing Address - Country:US
Mailing Address - Phone:626-464-4314
Mailing Address - Fax:626-603-6994
Practice Address - Street 1:1400 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3603
Practice Address - Country:US
Practice Address - Phone:626-464-4314
Practice Address - Fax:626-603-6994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)