Provider Demographics
NPI:1255451241
Name:LAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:LAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-847-3329
Mailing Address - Street 1:17822 BEACH BLVD
Mailing Address - Street 2:SUITE 442
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-7101
Mailing Address - Country:US
Mailing Address - Phone:714-847-3329
Mailing Address - Fax:714-847-4085
Practice Address - Street 1:14 TORREY PINES LN
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5139
Practice Address - Country:US
Practice Address - Phone:714-847-3329
Practice Address - Fax:714-847-4085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-31
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40353208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA29107Medicare UPIN
CACA330AMedicare PIN