Organization
MINK RADIOLOGIC IMAGING MEDICAL ASSOCIATES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERROLD MINK M.D. (MEDICAL DIRECTOR)
(310) 358-2100
Entity
Organization
Contact information
Practice address
8670 WILSHIRE BLVD STE 101, SUITE 101, BEVERLY HILLS, CA 90211-2930
(310) 358-2100
Mailing address
PO BOX 190, SIMI VALLEY, CA 93062-0190
(805) 522-5940
(805) 522-6401
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA6633
RAILROAD MEDICARE
—
01
—
ZZZ06391Z
BLUE SHIELD
—
01
—
ZZZ66023Z
BLUE SHIELD
—
01
—
ZZZ77048Z
BLUE SHIELD
—
Enumeration date
05/19/2006
Last updated
10/08/2013
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