05D0663605 CLIA NUMBER - LOS ANGELES DIALYSIS CENTER

Laboratory Demographics

  • CLIA Code: 05D0663605
  • Facility Name: LOS ANGELES DIALYSIS CENTER
  • Facility Address: 3901 S WESTERN AVE
    LOS ANGELES, CA
    ZIP 90062
  • Facility Phone: 323 294-0670
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JACK RUBIN MD
  • NPI Number: 1841547460
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0663605
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name LOS ANGELES DIALYSIS CENTER
Street 3901 S WESTERN AVE
City LOS ANGELES
State CA
ZIP 90062
Phone 323 294-0670
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/1/2024
Certificate Expiration Date 8/31/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JACK RUBIN MD

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This page was last updated on: 9/29/2025