Provider Demographics
NPI:1609955681
Name:HEALTH DIAGNOSTIC CENTER
Entity type:Organization
Organization Name:HEALTH DIAGNOSTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GRACHIK
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:KELOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-662-2970
Mailing Address - Street 1:3171 LOS FELIZ BLVD
Mailing Address - Street 2:212
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1527
Mailing Address - Country:US
Mailing Address - Phone:323-662-2970
Mailing Address - Fax:323-662-2970
Practice Address - Street 1:3171 LOS FELIZ BLVD
Practice Address - Street 2:212
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1527
Practice Address - Country:US
Practice Address - Phone:323-662-2970
Practice Address - Fax:323-662-2970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATG 4272471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATG 427Medicare ID - Type UnspecifiedMEDICARE NUMBER