Provider Demographics
NPI:1568981124
Name:ALTERA LABORATORY SERVICES LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:ALTERA LABORATORY SERVICES LIMITED LIABILITY COMPANY
Other - Org Name:ALTERA LABORATORY SERVICES, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MUN
Authorized Official - Middle Name:KU
Authorized Official - Last Name:KANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-403-3424
Mailing Address - Street 1:16902 MILLIKAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-5012
Mailing Address - Country:US
Mailing Address - Phone:951-403-3424
Mailing Address - Fax:
Practice Address - Street 1:16902 MILLIKAN AVE STE B
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-5012
Practice Address - Country:US
Practice Address - Phone:951-403-3424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy