1467722918 NPI number — OLYMPUS RADIOLOGY MEDICAL GROUP INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467722918 NPI number — OLYMPUS RADIOLOGY MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLYMPUS RADIOLOGY MEDICAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467722918
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2835 MORAGA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90077-1614
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-458-7742
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3828 DELMAS TER
Provider Second Line Business Practice Location Address:
DEPT. OF RADIOLOGY
Provider Business Practice Location Address City Name:
CULVER CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90232-2713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-836-7001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/30/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AHDOOT
Authorized Official First Name:
ROBEN
Authorized Official Middle Name:
DAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-458-7742

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , registered in the state of NULL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)