Healthcare Provider Details

I. General information

NPI: 1255324018
Provider Name (Legal Business Name): STERLING PATHOLOGY MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 OLD RANCH PKWY SUITE 430
SEAL BEACH CA
90740-2765
US

IV. Provider business mailing address

3030 OLD RANCH PKWY SUITE 430
SEAL BEACH CA
90740-2766
US

V. Phone/Fax

Practice location:
  • Phone: 562-799-8900
  • Fax: 562-799-8901
Mailing address:
  • Phone: 562-799-8900
  • Fax: 562-799-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA622810
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA622810
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA62281A
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberCLF11783
License Number StateCA

VIII. Authorized Official

Name: MR. CHANGGAO YANG
Title or Position: CEO
Credential: M.D.
Phone: 562-799-8900