Provider Demographics
NPI:1124411947
Name:MOGENE CLINICAL DIAGNOSTICS LC
Entity Type:Organization
Organization Name:MOGENE CLINICAL DIAGNOSTICS LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DUN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-261-9999
Mailing Address - Street 1:1005 N WARSON RD STE 403A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2900
Mailing Address - Country:US
Mailing Address - Phone:314-261-9999
Mailing Address - Fax:
Practice Address - Street 1:1005 N WARSON RD STE 403A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2900
Practice Address - Country:US
Practice Address - Phone:314-261-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOGENE LC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory