Provider Demographics
NPI:1740628312
Name:PAN LABORATORIES
Entity type:Organization
Organization Name:PAN LABORATORIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOTHIBAI
Authorized Official - Middle Name:
Authorized Official - Last Name:PANDIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-336-4800
Mailing Address - Street 1:15375 BARRANCA PKWY
Mailing Address - Street 2:SUITE - E-101
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2217
Mailing Address - Country:US
Mailing Address - Phone:949-336-4800
Mailing Address - Fax:949-336-4801
Practice Address - Street 1:15375 BARRANCA PKWY
Practice Address - Street 2:SUITE - E-101
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2217
Practice Address - Country:US
Practice Address - Phone:949-336-4800
Practice Address - Fax:949-336-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF00343493291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2051927OtherCLIA