MEDICARE: PROCORP LAB INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1568345932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCORP LAB INC

Provider Business Mailing Address
First Line	:	9795 CABRINI DR STE 107
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-1739
Country	:	US
Telephone Number	:	818-474-7404
Fax Number	:

Provider Business Practice Location Address
First Line	:	9795 CABRINI DR STE 107
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-1739
Country	:	US
Telephone Number	:	818-474-7404
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	VAHAN KYANDIBEKYAN
Credential	:
Telephone Number	:	747-474-7404

Provider Enumeration Date	:	07/31/2025
Last Update Date	:	07/31/2025

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Directions to “PROCORP LAB INC ” Practice Location

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