Provider Demographics
NPI:1972954030
Name:PSOMAGEN INC
Entity type:Organization
Organization Name:PSOMAGEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JIWON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-251-1007
Mailing Address - Street 1:1330 PICCARD DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-9993
Mailing Address - Country:US
Mailing Address - Phone:301-251-1007
Mailing Address - Fax:301-251-4006
Practice Address - Street 1:1330 PICCARD DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-9993
Practice Address - Country:US
Practice Address - Phone:301-251-1007
Practice Address - Fax:301-251-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory