1447423991 NPI number — WHITTIER UROLOGICAL LAB, LLC

Table of content: (NPI 1447423991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447423991 NPI number — WHITTIER UROLOGICAL LAB, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITTIER UROLOGICAL LAB, LLC
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:
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:
1447423991
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8135 PAINTER AVE
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
WHITTIER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90602-3102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-907-7600
Provider Business Mailing Address Fax Number:
562-907-7602

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8135 PAINTER AVE
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
WHITTIER
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90602-3102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-907-7600
Provider Business Practice Location Address Fax Number:
562-907-7602
Provider Enumeration Date:
04/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YUN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
K
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
562-907-7600

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  G65131 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1265503965 . This is a "DR. LAI INDIV.NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1518037019 . This is a "DR.POLITO INDIV. NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1699847046 . This is a "DR.YUN INDIV. NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".