Lab Genomics, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF00341087 Issued in CA

Legal business name

LAB GENOMICS, LLC

Practice address

11160 Warner Ave Ste 415
Fountain Valley, CA 92708-4056

Phone

(714) 438-1009

Fax

(714) 438-2484

NPI assigned

Jul 21, 2011

Organization subpart

No

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

Authorized official

Name

Mrs. Susham Manaktala, CLS

Title

Executive Administration

Phone

(714) 336-1379

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Lab Genomics LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lab Genomics, LLC

  • Clinical Medical Laboratory
  • Brighton, MI
  • NPI 1134889470
  NPD tax ID

Locations

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344384000000",
    "number": "1225316482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11160 WARNER AVE STE 415",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084056",
            "telephone_number": "714-438-1009",
            "fax_number": "714-438-2484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11160 WARNER AVE STE 415",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927084056",
            "telephone_number": "714-438-1009",
            "fax_number": "714-438-2484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAB GENOMICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-21",
        "last_updated": "2012-08-08",
        "status": "A",
        "authorized_official_last_name": "MANAKTALA",
        "authorized_official_first_name": "SUSHAM",
        "authorized_official_title_or_position": "EXECUTIVE ADMINISTRATION",
        "authorized_official_telephone_number": "714-336-1379",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "CLS"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF00341087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA STATE",
            "identifier": "CLF00341087",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINICAL LAB IMPROVEMENT AMMENDMENT",
            "identifier": "05D2026572",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nathan Kwong, MD
• Ky T. Vu, M.D., Inc.
• Vincent Ky
• Kyt Dental Services
• Anhtu H. La, M.D.
• Laboratory Managment Specialist
• Labpro Diagnostics Inc.
• Labpro Diagnostics Inc.
• Vicente Rodriguez Lagunas
• Juliet Lai, PHARM.D.

• Clinical Medical Laboratory in Fountain Valley, CA
• Providers in Fountain Valley, 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 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.