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General NPI Number Information
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NPI Number | 1811226079
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Entity Type | Organization
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Legal Business Name | STARRY NIGHT INC
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 46356 WARM SPRINGS BLVD
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City | FREMONT
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State | CA
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Zip | 94539-7021
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Country | US
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Telephone | 510-713-1300
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Fax | 510-713-7202
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Provider Business Mailing Address
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Address Line | PO BOX 14858
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City | FREMONT
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State | CA
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Zip | 94539-1858
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Country | US
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Telephone | 510-713-1300
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Fax | 510-713-7202
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EVELYN E LI
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Credential | MD
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Telephone | 510-713-1300
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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 | G48660
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License Number State | CA
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