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Organization
MAK DIAGNOSTIC SERVICES, INC.
Active
Organization
MAK DIAGNOSTIC SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BORIS GERZENSHTEIN (ADMINISTRATOR)
(310) 289-0217
Entity
Organization
Contact information
Practice address
292 S LA CIENEGA BLVD, STE 202, BEVERLY HILLS, CA 90211-3330
(310) 289-0217
(310) 289-0372
Mailing address
8306 WILSHIRE BLVD, STE 210, BEVERLY HILLS, CA 90211-2382
(310) 289-0217
(310) 289-0372
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QR0208X
Mobile Radiology Clinic/Center
—
—
293D00000X
Physiological Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ44102Z
B/S ROVIDER NUMBER
CA
Enumeration date
12/01/2005
Last updated
06/11/2020
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