Healthcare Provider Details

I. General information

NPI: 1285279661
Provider Name (Legal Business Name): INNOVTECH HISTOPATHOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2019
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 N TUSTIN ST
ORANGE CA
92867-5958
US

IV. Provider business mailing address

663 S MELROSE ST
ANAHEIM CA
92805-4766
US

V. Phone/Fax

Practice location:
  • Phone: 714-609-5656
  • Fax:
Mailing address:
  • Phone: 714-609-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: YETHU KYAW
Title or Position: CEO
Credential:
Phone: 714-609-5656