Provider Demographics
NPI:1285279661
Name:INNOVTECH HISTOPATHOLOGY SERVICES
Entity type:Organization
Organization Name:INNOVTECH HISTOPATHOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YETHU
Authorized Official - Middle Name:
Authorized Official - Last Name:KYAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-609-5656
Mailing Address - Street 1:663 S MELROSE ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4766
Mailing Address - Country:US
Mailing Address - Phone:714-609-5656
Mailing Address - Fax:
Practice Address - Street 1:1022 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92867-5958
Practice Address - Country:US
Practice Address - Phone:714-609-5656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-09
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty