Provider Demographics
NPI:1043481971
Name:TIMM LABORATORY
Entity type:Organization
Organization Name:TIMM LABORATORY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:MORADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-776-3600
Mailing Address - Street 1:6850 CANBY AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4310
Mailing Address - Country:US
Mailing Address - Phone:818-776-3600
Mailing Address - Fax:818-654-0634
Practice Address - Street 1:6850 CANBY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4310
Practice Address - Country:US
Practice Address - Phone:818-776-3600
Practice Address - Fax:818-654-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLF328586291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACLF328586OtherCALIFORNIA DHS LICENSE