NPIMap

Organization Active NPI

Kent Pathology Laboratory PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Grand Rapids, MI
National Provider Identifier
1740397124
Registry record updated Jun 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
KENT PATHOLOGY LABORATORY PLLC
Practice address
2650 Horizon Dr SE
Suite B
Grand Rapids, MI 49546-7519
Phone
(616) 458-1255
Fax
(616) 458-1292
NPI assigned
Aug 23, 2006
Organization subpart
Yes
Parent organization
KENT PATHOLOGY LABORATORY PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 17, 2010

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

Authorized official

Name
Dr. Won Kyu Lee, M.D.
Title
Medical Director
Phone
(616) 774-0209

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology (Pathology) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZD0900X
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

2650 Horizon Dr SE
Suite B
Grand Rapids, MI 49546-7519

Mailing address

2650 Horizon Dr SE
Suite B
Grand Rapids, MI 49546-7519
Phone (616) 458-1255

Other names 1

  • Kent Pathology Laboratory LLC Former legal business name

National Provider Directory

National Provider Directory
Part of
Kent Pathology Lab LTD

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276732800000",
    "number": "1740397124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 HORIZON DR SE",
            "address_2": "SUITE B",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467519",
            "telephone_number": "616-458-1255",
            "fax_number": "616-458-1292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 HORIZON DR SE",
            "address_2": "SUITE B",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495467519",
            "telephone_number": "616-458-1255",
            "fax_number": "616-458-1292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT PATHOLOGY LABORATORY PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENT PATHOLOGY LABORATORY PLLC",
        "enumeration_date": "2006-08-23",
        "last_updated": "2010-06-17",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "WON",
        "authorized_official_middle_name": "KYU",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "616-774-0209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ZD0900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kent Pathology Laboratory LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2010; 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.