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
—
—
Other
Enumeration date
09/09/2008
Last updated
08/05/2025
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