Provider Demographics
NPI:1851915888
Name:PANGEA LABORATORY LLC
Entity Type:Organization
Organization Name:PANGEA LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YAP
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-346-9393
Mailing Address - Street 1:14762 BENTLEY CIR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7226
Mailing Address - Country:US
Mailing Address - Phone:493-469-3939
Mailing Address - Fax:813-642-4907
Practice Address - Street 1:14762 BENTLEY CIR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7226
Practice Address - Country:US
Practice Address - Phone:949-346-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
05D2120654OtherINDEPENDENT CLINICAL LABORATORY