Provider Demographics
NPI:1578224556
Name:GDXLAB INC
Entity Type:Organization
Organization Name:GDXLAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG SOON
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOKNO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-255-2280
Mailing Address - Street 1:770 W HAMPDEN AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2121
Mailing Address - Country:US
Mailing Address - Phone:202-738-6723
Mailing Address - Fax:
Practice Address - Street 1:770 W HAMPDEN AVE STE 125
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2121
Practice Address - Country:US
Practice Address - Phone:720-255-2280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory