Provider Demographics
NPI:1144928862
Name:KEMPO LAB LLC
Entity type:Organization
Organization Name:KEMPO LAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MEHMET
Authorized Official - Middle Name:E
Authorized Official - Last Name:ILIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-758-0104
Mailing Address - Street 1:13601 PRESTON RD STE 425W
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-4985
Mailing Address - Country:US
Mailing Address - Phone:214-758-0104
Mailing Address - Fax:214-758-0049
Practice Address - Street 1:13601 PRESTON RD STE 425W
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-4985
Practice Address - Country:US
Practice Address - Phone:214-758-0104
Practice Address - Fax:214-758-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory