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Organization
THE PATHOLOGY GROUP, INC.
Active
Organization
THE PATHOLOGY GROUP, INC.
Active
Other names
St Jude Pathology Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BOONYASAMPANT M.D. (PRESIDENT)
(714) 446-7505
Entity
Organization
Contact information
Practice address
101 E VALENCIA MESA DR, FULLERTON, CA 92835-3809
(714) 446-7505
(714) 992-3055
Mailing address
FILE 749241, LOS ANGELES, CA 90074-0001
(714) 446-7505
(714) 992-3055
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
NULL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
09/09/2008
Last updated
08/05/2025
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