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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