Healthcare Provider Details

I. General information

NPI: 1912655614
Provider Name (Legal Business Name): PRIME DX LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 N ECKHOFF ST STE 125
ORANGE CA
92868-1006
US

IV. Provider business mailing address

744 N ECKHOFF ST STE 125
ORANGE CA
92868-1006
US

V. Phone/Fax

Practice location:
  • Phone: 714-343-3726
  • Fax: 833-668-2329
Mailing address:
  • Phone: 657-456-1743
  • Fax: 833-668-2329

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: TALHA KHAN
Title or Position: OWNER
Credential:
Phone: 657-456-1743