Provider Demographics
NPI:1255324018
Name:STERLING PATHOLOGY MEDICAL CORPORATION
Entity Type:Organization
Organization Name:STERLING PATHOLOGY MEDICAL CORPORATION
Other - Org Name:STERLING PATHOLOGY NATL LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANGGAO
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-799-8900
Mailing Address - Street 1:3030 OLD RANCH PKWY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2766
Mailing Address - Country:US
Mailing Address - Phone:562-799-8900
Mailing Address - Fax:562-799-8901
Practice Address - Street 1:3030 OLD RANCH PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2765
Practice Address - Country:US
Practice Address - Phone:562-799-8900
Practice Address - Fax:562-799-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA622810207ZD0900X, 207ZH0000X
CAA62281A207ZP0102X
CACLF11783291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF11783OtherCALIFORNIA LAB LICENSE
CA00A622810Medicaid
CA00A622810Medicaid
CACLF11783OtherCALIFORNIA LAB LICENSE
CA=========OtherEIN
CAWA62281BMedicare ID - Type UnspecifiedINDIVIDUAL #