Provider Demographics
NPI:1548396831
Name:WHITTIER PATHOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:WHITTIER PATHOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HONDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-698-0811
Mailing Address - Street 1:PO BOX 511246
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3045
Mailing Address - Country:US
Mailing Address - Phone:562-698-0811
Mailing Address - Fax:562-789-4355
Practice Address - Street 1:12401 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1006
Practice Address - Country:US
Practice Address - Phone:562-906-5500
Practice Address - Fax:562-789-6872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP6270OtherRAILROAD MEDICARE
CAGR0048460Medicaid
CAZZZ54603ZOtherBLUE SHIELD
CACP6270OtherRAILROAD MEDICARE