Provider Demographics
NPI:1053004358
Name:KBK LABORATORY & MED SPA, L.L.P.
Entity type:Organization
Organization Name:KBK LABORATORY & MED SPA, L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATRECE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-971-4778
Mailing Address - Street 1:3626 LATROBE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1799
Mailing Address - Country:US
Mailing Address - Phone:980-332-2384
Mailing Address - Fax:980-495-8819
Practice Address - Street 1:3626 LATROBE DR STE 300
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1799
Practice Address - Country:US
Practice Address - Phone:980-332-2384
Practice Address - Fax:980-495-8819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory