Provider Demographics
NPI:1003128646
Name:CORE DIAGNOSTICS INC.
Entity Type:Organization
Organization Name:CORE DIAGNOSTICS INC.
Other - Org Name:ONCOMDX INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISHNAMURTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:BALACHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-532-9506
Mailing Address - Street 1:3535 BREAKWATER AVE
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-3610
Mailing Address - Country:US
Mailing Address - Phone:650-532-9500
Mailing Address - Fax:650-532-9550
Practice Address - Street 1:3535 BREAKWATER AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-3610
Practice Address - Country:US
Practice Address - Phone:650-532-9500
Practice Address - Fax:650-532-9550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-12
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory