Pacific Clinical Laboratories Inc

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF10883 Issued in CA

Legal business name

PACIFIC CLINICAL LABORATORIES INC

Practice address

9675 Brighton Way
B200
Beverly Hills, CA 90210-5144

Phone

(310) 246-0025

NPI assigned

Nov 13, 2006

Organization subpart

No

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

Authorized official

Name

Dmitry Y Ivanov

Title

President

Phone

(310) 246-0025

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508937681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9675 BRIGHTON WAY",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902105144",
            "telephone_number": "310-246-0025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9675 BRIGHTON WAY",
            "address_2": "B200",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902105144",
            "telephone_number": "310-246-0025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC CLINICAL LABORATORIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IVANOV",
        "authorized_official_first_name": "DMITRY",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-246-0025"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF10883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Medical Laboratory in Beverly Hills, CA
• Providers in Beverly Hills, 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.