Provider Demographics
NPI:1205000841
Name:METIC TRANSPLANTATION LABORATORIES, INC.
Entity Type:Organization
Organization Name:METIC TRANSPLANTATION LABORATORIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT (OWNER)
Authorized Official - Prefix:DR
Authorized Official - First Name:YUICHI
Authorized Official - Middle Name:
Authorized Official - Last Name:IWAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-441-1111
Mailing Address - Street 1:1420 SAN PABLO ST
Mailing Address - Street 2:PMB B-103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-9047
Mailing Address - Country:US
Mailing Address - Phone:323-442-7088
Mailing Address - Fax:323-442-6742
Practice Address - Street 1:1420 SAN PABLO ST
Practice Address - Street 2:PMB B-103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-9047
Practice Address - Country:US
Practice Address - Phone:323-442-7088
Practice Address - Fax:323-442-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D0545320291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
05HL05Medicare PIN