Provider Demographics
NPI:1184834038
Name:BIOMEGA CORPORATION
Entity Type:Organization
Organization Name:BIOMEGA CORPORATION
Other - Org Name:PSL (PREFERRED SPECIALTY LABORATORY)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-761-7200
Mailing Address - Street 1:4426 CERRITOS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2549
Mailing Address - Country:US
Mailing Address - Phone:714-761-7200
Mailing Address - Fax:714-761-5225
Practice Address - Street 1:4426 CERRITOS AVE
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2549
Practice Address - Country:US
Practice Address - Phone:714-761-7200
Practice Address - Fax:714-761-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF 11218291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory