# THE PATHOLOGY GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** St Jude Pathology Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316196892
- **Authorized official:** MARK BOONYASAMPANT M.D. (PRESIDENT)
- **Authorized official phone:** (714) 446-7505

## Contact information

- **Practice address:** 101 E VALENCIA MESA DR, FULLERTON, CA 92835-3809
- **Practice address phone:** (714) 446-7505
- **Practice address fax:** (714) 992-3055
- **Mailing address:** FILE 749241, LOS ANGELES, CA 90074-0001
- **Mailing address phone:** (714) 446-7505
- **Mailing address fax:** (714) 992-3055

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | NULL | Yes |
| 207ZP0102X | Anatomic Pathology & Clinical Pathology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/09/2008
- **Last updated:** 08/05/2025