Provider Demographics
NPI:1700824869
Name:MD ASSOCIATES LABORATORY, INC.
Entity Type:Organization
Organization Name:MD ASSOCIATES LABORATORY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:N
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MT(ASCP) CLS
Authorized Official - Phone:714-539-4800
Mailing Address - Street 1:9353 BOLSA AVE
Mailing Address - Street 2:# D44
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5951
Mailing Address - Country:US
Mailing Address - Phone:714-539-4800
Mailing Address - Fax:714-590-4888
Practice Address - Street 1:10372 TRASK AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-3200
Practice Address - Country:US
Practice Address - Phone:714-539-4800
Practice Address - Fax:714-590-4888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF11773291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1009476Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER