Provider Demographics
NPI:1033578604
Name:GOLDSTAR LABORATORIES OHIO LLC
Entity Type:Organization
Organization Name:GOLDSTAR LABORATORIES OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ZY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHLAIMOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-589-8900
Mailing Address - Street 1:93 CANYON CRK
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0424
Mailing Address - Country:US
Mailing Address - Phone:310-589-8900
Mailing Address - Fax:
Practice Address - Street 1:4126 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3018
Practice Address - Country:US
Practice Address - Phone:310-589-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory