Provider Demographics
NPI:1821253584
Name:AGENDIA INC
Entity Type:Organization
Organization Name:AGENDIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JIA-PERNG
Authorized Official - Last Name:WEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:949-540-6300
Mailing Address - Street 1:22 MORGAN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2022
Mailing Address - Country:US
Mailing Address - Phone:949-540-6300
Mailing Address - Fax:866-306-0220
Practice Address - Street 1:22 MORGAN
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2022
Practice Address - Country:US
Practice Address - Phone:949-540-6300
Practice Address - Fax:866-306-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL800025572OtherSTATE OF FLORIDA LICENSE NUMBER
NYCAP 7223853OtherLAP NUMBER
NY05D1089250OtherCLIA
FL800025572OtherSTATE OF FLORIDA LICENSE NUMBER