Healthcare Provider Details

I. General information

NPI: 1962367383
Provider Name (Legal Business Name): GILAN CLINICAL LABORATORY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11999 KATY FWY STE 225
HOUSTON TX
77079-1605
US

IV. Provider business mailing address

11999 KATY FWY STE 225
HOUSTON TX
77079-1605
US

V. Phone/Fax

Practice location:
  • Phone: 832-553-8869
  • Fax: 832-772-6321
Mailing address:
  • Phone: 832-553-8869
  • Fax: 832-772-6321

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: MEHRAN HAIDARI
Title or Position: OWNER
Credential:
Phone: 832-553-8869