05D0687240 CLIA NUMBER - KIM FREDERICKSON MD

Laboratory Demographics

  • CLIA Code: 05D0687240
  • Facility Name: KIM FREDERICKSON MD
  • Facility Address: 867 DIABLO AVE
    NOVATO, CA
    ZIP 94947
  • Facility Phone: 415 892-0754
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: KIM S. FREDERICKSON MD
  • NPI Number: 1003995291
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 05D0687240
LAB Type Physician Office
Facility Name KIM FREDERICKSON MD
Street 867 DIABLO AVE
City NOVATO
State CA
ZIP 94947
Phone 415 892-0754
Certificate Type Certificate of Compliance
Certificate Type Description This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.
Certificate Effective Date 3/22/2025
Certificate Expiration Date 3/21/2027
Facility Type Physician Office
Lab Director KIM S. FREDERICKSON MD

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