Organization
MN CLINICAL LABORATORY INC
Active
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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