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General NPI Number Information
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NPI Number | 1356735989
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Entity Type | Organization
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Legal Business Name | SPECIALIZED UNIVERSITY PATHOLOGISTS
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Dates
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Enumeration Date | 03/20/2015
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 931 BUENA VISTA ST STE 200B
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City | DUARTE
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State | CA
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Zip | 91010-1713
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Country | US
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Telephone | 424-302-3307
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 745227
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City | LOS ANGELES
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State | CA
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Zip | 90074-5227
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Country | US
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Telephone | 424-245-7284
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Fax |
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. KIARASH MICHEL
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Credential | MD
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Telephone | 424-245-7284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | G81612
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License Number State | CA
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