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General NPI Number Information
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NPI Number | 1669127346
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Entity Type | Organization
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Legal Business Name | ILLUMINATE DIAGNOSTICS INC
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 2670 N MAIN ST STE 101
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City | SANTA ANA
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State | CA
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Zip | 92705-6639
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Country | US
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Telephone | 562-231-6828
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Fax | 562-403-1401
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Provider Business Mailing Address
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Address Line | 2670 N MAIN ST STE 101
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City | SANTA ANA
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State | CA
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Zip | 92705-6639
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Country | US
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Telephone | 562-231-6828
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ALEX KANG
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Credential |
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Telephone | 949-689-3154
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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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