Kent Pathology Laboratory PLLC
Pathology, Anatomic Pathology & Clinical Pathology in Grand Rapids, MI. Organization (NPI-2).
NPI number1740397124
StatusActive
Last updated in NPPESJun 17, 2010
Details
- NPI
- 1740397124
- Entity type
- Organization (NPI-2)
- Legal business name
- Kent Pathology Laboratory PLLC
- Organization subpart
- Yes
- Enumeration date
- Aug 23, 2006
- Last updated
- Jun 17, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207ZP0102X | Pathology, Anatomic Pathology & Clinical Pathology | – | – | Yes |
| 207ZD0900X | Pathology, Dermatopathology | – | – |
Other names
- Kent Pathology Laboratory LLC (Former Legal Business Name)
Practice location
2650 Horizon Dr SeSuite B
Grand Rapids, MI 49546-7519
Phone 616-458-1255 · Fax 616-458-1292
Mailing address
2650 Horizon Dr SeSuite B
Grand Rapids, MI 49546-7519
Phone 616-458-1255 · Fax 616-458-1292
Authorized official
Won Kyu Lee
Medical Director
6167740209
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