Magnabloom LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

MAGNABLOOM LLC

Doing business as

South Bay Laboratories

Practice address

1403 Lomita Blvd Ste 302
Harbor City, CA 90710-2085

Phone

(424) 482-8789

NPI assigned

Jun 11, 2024

Organization subpart

No

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

Authorized official

Name

Jonathan Napitupulu

Title

Manager

Phone

(310) 975-4532

Specialties & licenses 1

Addresses

Other names 1

• South Bay Laboratories Doing business as

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

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Young Sun Yi

  • Anesthesiology Physician
  • Los Angeles, CA
  • NPI 1043366818
  NPD (past)

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

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1649012477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1403 LOMITA BLVD STE 302",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907102085",
            "telephone_number": "424-482-8789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1403 LOMITA BLVD STE 302",
            "city": "HARBOR CITY",
            "state": "CA",
            "postal_code": "907102085",
            "telephone_number": "424-482-8789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNABLOOM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-11",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "NAPITUPULU",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "310-975-4532"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Bay Laboratories",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janice Marie Maddox, RRT
• Tonya Maekawa
• Khiet T Maemura, OD
• Hyunsook Maeng, LPC
• Karina Briana Mageo
• Magnorm Healthcare Services, Inc.
• Rajinder N. Mahajan, MD
• Nakia Theresa Mainor-Roth, MD
• Lilavati Irma Makineni, PA-C
• Jessica Malisa, MD

• Clinical Medical Laboratory in Harbor City, CA
• Providers in Harbor City, 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 Jun 12, 2024; 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.