Provider Demographics
NPI:1922772409
Name:PROFESSIONAL LABS INCORPORATED
Entity Type:Organization
Organization Name:PROFESSIONAL LABS INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAI
Authorized Official - Middle Name:YING
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-999-0994
Mailing Address - Street 1:222 N COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7810
Mailing Address - Country:US
Mailing Address - Phone:909-999-0994
Mailing Address - Fax:
Practice Address - Street 1:222 N COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7810
Practice Address - Country:US
Practice Address - Phone:909-999-0994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory