05D0868016 CLIA NUMBER - DONG S KIM MD

Laboratory Demographics

  • CLIA Code: 05D0868016
  • Facility Name: DONG S KIM MD
  • Facility Address: 11441 HEACOCK ST STE F
    MORENO VALLEY, CA
    ZIP 92557
  • Facility Phone: 951 243-8000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DONG S. KIM MD
  • NPI Number: 1942267992
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 05D0868016
LAB Type Physician Office
Facility Name DONG S KIM MD
Street 11441 HEACOCK ST STE F
City MORENO VALLEY
State CA
ZIP 92557
Phone 951 243-8000
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 DONG S. KIM MD

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