Organization
LA GOOD SAMARITAN PATHOLOGY MEDICAL GROUP, INC.
Active
Organization
LA GOOD SAMARITAN PATHOLOGY MEDICAL GROUP, INC.
Active
Other names
ADVANCED CLINICAL LABORATORIES
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHAHRAM KHIAL PH.D. (PRESIDENT/OWNER)
(818) 216-0725
Entity
Organization
Contact information
Practice address
2777 PACIFIC AVE, SUITE H201& I202, LONG BEACH, CA 90806-2625
(562) 981-0100
(562) 981-0600
Mailing address
15021 VENTURA BLVD., SUITE #771, SHERMAN OAKS, CA 91403-2442
(562) 981-0100
(562) 981-0600
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF0001448
CA
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ED741A
PTAN ID #
CA
05
—
LAB02841F
—
CA
01
—
ZZZ55908Z
BLUE SHIELD
CA
Enumeration date
03/28/2006
Last updated
12/30/2014
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