Progene Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CCF11452 Issued in CA

Legal business name

PROGENE INC

Practice address

116 East Broadway
Glendale, CA 91205

Phone

(818) 548-0999

Fax

(818) 548-1555

NPI assigned

Apr 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tuan Ngoc Tran

Title

President Ceo

Phone

(818) 548-0999

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• University Childrens Genetics Laboratory Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114147253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 EAST BROADWAY",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91205",
            "telephone_number": "818-548-0999",
            "fax_number": "818-548-1555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 EAST BROADWAY",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91205",
            "telephone_number": "818-548-0999",
            "fax_number": "818-548-1555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGENE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TRAN",
        "authorized_official_first_name": "TUAN",
        "authorized_official_middle_name": "NGOC",
        "authorized_official_title_or_position": "PRESIDENT CEO",
        "authorized_official_telephone_number": "818-548-0999"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CCF11452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAP",
            "identifier": "6915201",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University Childrens Genetics Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Glendale, CA
• Providers in Glendale, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.