Provider Demographics
NPI:1518585108
Name:FULGENT THERAPEUTICS, LLC.
Entity Type:Organization
Organization Name:FULGENT THERAPEUTICS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-350-0537
Mailing Address - Street 1:4978 SANTA ANITA AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3600
Mailing Address - Country:US
Mailing Address - Phone:626-350-0537
Mailing Address - Fax:
Practice Address - Street 1:8560 KATY FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-1847
Practice Address - Country:US
Practice Address - Phone:626-350-0537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FULGENT THERAPEUTICS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2043189OtherCENTERS FOR MEDICARE & MEDICAID SERVICES
CACDF-00342581OtherCALIFORNIA DEPARTMENT OF PUBLIC HEALTH