05D0693128 CLIA NUMBER - HELEN C KOO MD

Laboratory Demographics

CLIA Number: 05D0693128

Facility Name: HELEN C KOO MD

Facility Address:
265 E BEVERLY BLVD 2ND FLOOR
MONTEBELLO, CA
ZIP 90640
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Facility Phone Number: 213 721-4922

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1477596864

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D0693128
LAB Type	Physician Office
Facility Name	HELEN C KOO MD
Street	265 E BEVERLY BLVD 2ND FLOOR
City	MONTEBELLO
State	CA
ZIP	90640
Phone	213 721-4922
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024