05D0720261 CLIA NUMBER - FAIRWAY CHILDREN'S MEDICAL GROUP LABORATORY

Laboratory Demographics

  • CLIA Code: 05D0720261
  • Facility Name: FAIRWAY CHILDREN'S MEDICAL GROUP LABORATORY
  • Facility Address: 2707 E. VALLEY BLVD, STE 215
    WEST COVINA, CA
    ZIP 91792
  • Facility Phone: 909 594-3382
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: EVA Y. CHAN
  • NPI Number: 1508953894
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D0720261
LAB Type Physician Office
Facility Name FAIRWAY CHILDREN'S MEDICAL GROUP LABORATORY
Street 2707 E. VALLEY BLVD, STE 215
City WEST COVINA
State CA
ZIP 91792
Phone 909 594-3382
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 EVA Y. CHAN

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