05D0675773 CLIA NUMBER - CHULHWE KOO MD

Laboratory Demographics

  • CLIA Code: 05D0675773
  • Facility Name: CHULHWE KOO MD
  • Facility Address: 3975 JACKSON ST #305
    RIVERSIDE, CA
    ZIP 92503
  • Facility Phone: 909 352-5070
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHULHUSE KOO
  • NPI Number: 1588628408
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D0675773
LAB Type Physician Office
Facility Name CHULHWE KOO MD
Street 3975 JACKSON ST #305
City RIVERSIDE
State CA
ZIP 92503
Phone 909 352-5070
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 Physician Office
Lab Director CHULHUSE KOO

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