MN Clinical Laboratory Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF1817 Issued in CA

Legal business name

MN CLINICAL LABORATORY INC

Practice address

1327 S Myrtle Ave
Monrovia, CA 91016-4150

Phone

(626) 303-8674

Fax

(310) 577-7560

NPI assigned

Jan 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Joon Sueck Lee, MEDICAL DOCTOR MD

Title

Medical Director

Phone

(310) 429-8711

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254873600000",
    "number": "1457405540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4712 ADMIRALTY WAY",
            "address_2": "# 1010",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926905",
            "telephone_number": "310-429-8711",
            "fax_number": "310-577-7560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1327 S MYRTLE AVE",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910164150",
            "telephone_number": "626-303-8674",
            "fax_number": "310-577-7560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MN CLINICAL LABORATORY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-23",
        "last_updated": "2009-10-07",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "JOON",
        "authorized_official_middle_name": "SUECK",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "310-429-8711",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MEDICAL DOCTOR MD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF1817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHOC HEALTH ALLIANCE",
            "identifier": "95438506",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAL OPTIMA DIRECT",
            "identifier": "LAB72547G",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LAB72547G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Monrovia, CA
• Providers in Monrovia, 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 Oct 7, 2009; 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.