Provider Demographics
NPI:1407450760
Name:ADVANCED GENETICS
Entity Type:Organization
Organization Name:ADVANCED GENETICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-902-6990
Mailing Address - Street 1:3650 NW 82ND AVENUE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6694
Mailing Address - Country:US
Mailing Address - Phone:305-902-6990
Mailing Address - Fax:626-507-3136
Practice Address - Street 1:3650 NW 82ND AVENUE
Practice Address - Street 2:SUITE 307
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-6694
Practice Address - Country:US
Practice Address - Phone:305-902-6990
Practice Address - Fax:626-507-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10F2200505OtherCLIA