Provider Demographics
NPI:1093045825
Name:HUNTINGTON BEACH CLINICAL LABORATORY INC
Entity type:Organization
Organization Name:HUNTINGTON BEACH CLINICAL LABORATORY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VOYLOSHNIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-843-9600
Mailing Address - Street 1:8071 SLATER AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6960
Mailing Address - Country:US
Mailing Address - Phone:714-843-9600
Mailing Address - Fax:714-717-4230
Practice Address - Street 1:8071 SLATER AVE
Practice Address - Street 2:STE 100
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6960
Practice Address - Country:US
Practice Address - Phone:714-843-9600
Practice Address - Fax:714-717-4230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-29
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05D1080532291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF 334485OtherCLINICAL LABORATORY LICENSE