La Good Samaritan Pathology Medical Group, Inc.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF0001448 Issued in CA

Legal business name

LA GOOD SAMARITAN PATHOLOGY MEDICAL GROUP, INC.

Practice address

2777 Pacific Ave
Suite H201& I202
Long Beach, CA 90806-2625

Phone

(562) 981-0100

Fax

(562) 981-0600

NPI assigned

Mar 28, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Shahram Khial, PH.D.

Title

President/Owner

Phone

(818) 216-0725

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• ADVANCED CLINICAL LABORATORIES Doing business as

Locations

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1419897600000",
    "number": "1336100759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15021 VENTURA BLVD.",
            "address_2": "SUITE #771",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914032442",
            "telephone_number": "562-981-0100",
            "fax_number": "562-981-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2777 PACIFIC AVE",
            "address_2": "SUITE H201& I202",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062625",
            "telephone_number": "562-981-0100",
            "fax_number": "562-981-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA GOOD SAMARITAN PATHOLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2014-12-30",
        "status": "A",
        "authorized_official_last_name": "KHIAL",
        "authorized_official_first_name": "SHAHRAM",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "818-216-0725",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF0001448",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ55908Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN ID #",
            "identifier": "ED741A",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB02841F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVANCED CLINICAL LABORATORIES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Long Beach, CA
• Providers in Long Beach, 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 Dec 30, 2014; 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.