Organization
COMMUNITY IMAGING MEDICAL GROUP INC
Active
Other names
Duke K Bahn MD a Professional
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES NORTH MD (PRESIDENT)
(805) 652-5093
Entity
Organization
Contact information
Practice address
168 N BRENT ST, SUITE 401, VENTURA, CA 93003-2824
(805) 652-5093
Mailing address
DEPT LA 21580, PASADENA, CA 91185-1580
(949) 263-8620
(949) 263-1639
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0091500
BLUE SHIELD
CA
05
—
GR0091501
—
CA
01
—
ZZZ03841Z
BLUE SHIELD OF CA
CA
01
—
ZZZ04836Z
BLUE SHIELD
CA
01
—
ZZZ04837Z
BLUE SHIELD
CA
Enumeration date
05/25/2006
Last updated
10/29/2009
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