Provider Demographics
NPI:1689281784
Name:CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH LABORATORY DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:510-412-5846
Mailing Address - Street 1:850 MARINA BAY PKWY BLDG P
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-6403
Mailing Address - Country:US
Mailing Address - Phone:510-412-5846
Mailing Address - Fax:510-412-5848
Practice Address - Street 1:28454 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4172
Practice Address - Country:US
Practice Address - Phone:510-412-5846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory