Healthcare Provider Details

I. General information

NPI: 1093614331
Provider Name (Legal Business Name): KEY GOLDEN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2026
Last Update Date: 11/03/2026
Certification Date: 11/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 W LIBERTY RD
GRIDLEY CA
95948-9561
US

IV. Provider business mailing address

1957 W LIBERTY RD
GRIDLEY CA
95948-9561
US

V. Phone/Fax

Practice location:
  • Phone: 571-749-2211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CLINTON LEE
Title or Position: MANAGER
Credential:
Phone: 571-749-2211