05D0704200 CLIA NUMBER - SUTTER GOULD MEDICAL FOUNDATION - TRACY DERMATOLOGY

Laboratory Demographics

  • CLIA Code: 05D0704200
  • Facility Name: SUTTER GOULD MEDICAL FOUNDATION - TRACY DERMATOLOGY
  • Facility Address: 445 W EATON AVE, STE 110 B
    TRACY, CA
    ZIP 95376
  • Facility Phone: 209 485-5463
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: DR. GANG CHENG
  • NPI Number: 1386003424
  • Taxonomy: 208600000X - Surgery

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CLIA Record

Field Name Field Value
CLIA Number 05D0704200
LAB Type Physician Office
Facility Name SUTTER GOULD MEDICAL FOUNDATION - TRACY DERMATOLOGY
Street 445 W EATON AVE, STE 110 B
City TRACY
State CA
ZIP 95376
Phone 209 485-5463
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 9/30/2024
Certificate Expiration Date 9/29/2026
Facility Type Physician Office
Lab Director DR. GANG CHENG

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This page was last updated on: 6/4/2025