Provider Demographics
NPI:1447905369
Name:MY GENIUS LAB LLC
Entity type:Organization
Organization Name:MY GENIUS LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SETANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-649-8611
Mailing Address - Street 1:655 N CENTRAL AVE STE 1734
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-1422
Mailing Address - Country:US
Mailing Address - Phone:818-649-8611
Mailing Address - Fax:323-544-6044
Practice Address - Street 1:655 N CENTRAL AVE STE 1734
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1422
Practice Address - Country:US
Practice Address - Phone:818-649-8611
Practice Address - Fax:323-544-6044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MY GENIUS LAB LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory