Organization
IGENOME, INC.
Active
Other names
iGENOME CANCER INSTITUTE
Organization subpart
No
Provider details
NPI number
Authorized official
YU SONG (CEO)
(267) 896-2176
Entity
Organization
Contact information
Practice address
1 WORLD TRADE CTR FL 8, LONG BEACH, CA 90831-0002
(267) 896-2176
Mailing address
1835 CHESTNUT ST APT 3R, PHILADELPHIA, PA 19103-3702
(267) 896-2176
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
207RX0202X
Medical Oncology Physician
—
—
261Q00000X
Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
MEDICAID
CA
05
—
PENDING
—
MA
05
—
PENDING
—
NJ
05
—
PENDING
—
NY
05
—
PENDING
—
PA
Enumeration date
04/15/2020
Last updated
04/20/2020
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