Organization
MN CLINICAL LABORATORY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOON SUECK LEE MEDICAL DOCTOR MD (MEDICAL DIRECTOR)
(310) 429-8711
Entity
Organization
Contact information
Practice address
1327 S MYRTLE AVE, MONROVIA, CA 91016-4150
(626) 303-8674
(310) 577-7560
Mailing address
4712 ADMIRALTY WAY, # 1010, MARINA DEL REY, CA 90292-6905
(310) 429-8711
(310) 577-7560
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF1817
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95438506
CHOC HEALTH ALLIANCE
CA
01
—
LAB72547G
CAL OPTIMA DIRECT
CA
05
—
LAB72547G
—
CA
Enumeration date
01/23/2007
Last updated
10/07/2009
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