=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952976011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CELLTECHGEN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2021
-----------------------------------------------------
Last Update Date | 10/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14780 MEMORIAL DR STE 103
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-5284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-994-4100
-----------------------------------------------------
Fax | 281-531-7940
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14780 MEMORIAL DR STE 103
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77079-5284
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-994-4100
-----------------------------------------------------
Fax | 281-531-7940
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SCIENTIFIC SUPERVISOR
-----------------------------------------------------
Name | DR. XIAOHUA ZENG
-----------------------------------------------------
Credential | PH.D
-----------------------------------------------------
Telephone | 832-606-1724
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------