Provider Demographics
NPI:1083366058
Name:SUDHA1 LLC
Entity Type:Organization
Organization Name:SUDHA1 LLC
Other - Org Name:MOON LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JISIT
Authorized Official - Middle Name:VIJAY
Authorized Official - Last Name:ZAVERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-347-3907
Mailing Address - Street 1:95 W THACKER ST
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-3378
Mailing Address - Country:US
Mailing Address - Phone:847-347-3907
Mailing Address - Fax:
Practice Address - Street 1:95 W THACKER ST
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-3378
Practice Address - Country:US
Practice Address - Phone:847-347-3907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-21
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory