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General NPI Number Information
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NPI Number | 1154939650
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Entity Type | Organization
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Legal Business Name | CROWN LABORATORIES LLC
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Dates
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Enumeration Date | 07/21/2020
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 17727 N 92ND WAY
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-6025
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Country | US
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Telephone | 160-252-5281
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Fax |
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Provider Business Mailing Address
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Address Line | 17727 N 92ND WAY
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-6025
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Country | US
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Telephone | 160-252-5281
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Fax |
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Authorized Official
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Title or Position | MD
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Name | SUNGCHUN LEE
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Credential | MD
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Telephone | 602-525-2819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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