Igenome, Inc.

Primary specialty

Critical Care Medicine (Internal Medicine) PhysicianTaxonomy code 207RC0200X

Legal business name

IGENOME, INC.

Practice address

1 World Trade Ctr FL 8
Long Beach, CA 90831-0002

Phone

(267) 896-2176

NPI assigned

Apr 15, 2020

Organization subpart

No

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

Authorized official

Name

Yu Song

Title

Ceo

Phone

(267) 896-2176

Specialties & licenses 5

Addresses

Other identifiers 5

Other names 1

• iGENOME CANCER INSTITUTE Doing business as

Electronic endpoints 2

Tax ID family

Igenome Cancer Institute4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Igenome, Inc.

  • Pharmacy
  • Long Beach, CA
  • NPI 1104446798
  NPD tax ID
• Igenome, Inc.

  • Clinic/Center
  • Long Beach, CA
  • NPI 1689294241
  NPD tax ID
• Igenome, Inc.

  • Clinical Medical Laboratory
  • Long Beach, CA
  • NPI 1871113431
  NPD tax ID

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

{
    "created_epoch": "1586908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587340800000",
    "number": "1770102105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1835 CHESTNUT ST APT 3R",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191033702",
            "telephone_number": "267-896-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 WORLD TRADE CTR FL 8",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908310002",
            "telephone_number": "267-896-2176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1835 Chestnut St Apt 3R",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191033702",
            "country_code": "US",
            "telephone_number": "267-896-2176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1640 Newport Blvd Ste 445",
            "address_purpose": "LOCATION",
            "city": "Costa Mesa",
            "state": "CA",
            "postal_code": "926277730",
            "country_code": "US",
            "telephone_number": "267-896-2176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "IGENOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-15",
        "last_updated": "2020-04-20",
        "certification_date": "2020-04-20",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "YU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "267-896-2176"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Medical Oncology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "PENDING",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.iGenomeHealth.org",
            "affiliation": "N",
            "endpointDescription": "Website, patient portal and app",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1 World Trade Ctr Fl 8",
            "city": "Long Beach",
            "state": "CA",
            "country_code": "US",
            "postal_code": "908310002",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.iGenomeHealth.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1835 Chestnut St Apt 3R",
            "city": "Philadelphia",
            "state": "PA",
            "country_code": "US",
            "postal_code": "191033702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "iGENOME CANCER INSTITUTE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "iGENOME CANCER INSTITUTE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mireille Ibrahim, RN
• Yoko Ichimura, LCPC
• Shala Idlibi
• Igenome, Inc.
• Igenome, Inc.
• Igenome, Inc.
• Jovan Iglesias
• Annalea Ignacio
• Grace Rogacion Ignacio, D.D.S
• Graciela Ignacio

• Critical Care Medicine (Internal Medicine) Physician in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Critical Care Medicine (Internal Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 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.