Provider Demographics
NPI:1437969698
Name:ATCG LABORATORY LLC
Entity type:Organization
Organization Name:ATCG LABORATORY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YTHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LINGAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-749-2165
Mailing Address - Street 1:3189 AIRWAY AVE # C300
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4612
Mailing Address - Country:US
Mailing Address - Phone:949-749-2165
Mailing Address - Fax:
Practice Address - Street 1:3189 AIRWAY AVE # C300
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4612
Practice Address - Country:US
Practice Address - Phone:949-749-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D2104354OtherCLIA
CACLF-00348523Medicaid