05D0707127 CLIA NUMBER - PROVIDENCE MEDICAL FOUNDATION

Laboratory Demographics

  • CLIA Code: 05D0707127
  • Facility Name: PROVIDENCE MEDICAL FOUNDATION
  • Facility Address: 27799 MEDICAL CENTER RD, STE 460
    MISSION VIEJO, CA
    ZIP 92691
  • Facility Phone: 949 347-0600
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: MINCH K. FONG MD
  • NPI Number: 1427305960
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0707127
LAB Type Physician Office
Facility Name PROVIDENCE MEDICAL FOUNDATION
Street 27799 MEDICAL CENTER RD, STE 460
City MISSION VIEJO
State CA
ZIP 92691
Phone 949 347-0600
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 1/23/2025
Certificate Expiration Date 1/22/2027
Facility Type Physician Office
Lab Director MINCH K. FONG MD

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