Provider Demographics
NPI:1063892396
Name:OTOGENETICS CORPORATION
Entity type:Organization
Organization Name:OTOGENETICS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PING
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:404-512-9616
Mailing Address - Street 1:PO BOX 744284
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-4284
Mailing Address - Country:US
Mailing Address - Phone:404-512-9616
Mailing Address - Fax:
Practice Address - Street 1:4553 WINTERS CHAPEL RD STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30360-2703
Practice Address - Country:US
Practice Address - Phone:855-686-4363
Practice Address - Fax:206-339-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory