Organization
EDEN LABORATORIES MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH LEIPPER MD (PRESIDENT)
(510) 889-5036
Entity
Organization
Contact information
Practice address
20103 LAKE CHABOT RD, CASTRO VALLEY, CA 94546-5341
(510) 889-5036
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0014940
—
CA
Enumeration date
04/04/2006
Last updated
08/22/2020
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