05D0920809 CLIA NUMBER - ID MED

Laboratory Demographics

  • CLIA Code: 05D0920809
  • Facility Name: ID MED
  • Facility Address: 23430 HAWTHORNE BLVD STE 200
    TORRANCE, CA
    ZIP 90505
  • Facility Phone: 310 784-5880
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: JOHN K. CHIA MD
  • NPI Number: 1154780559
  • Taxonomy: 207RI0200X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D0920809
LAB Type Physician Office
Facility Name ID MED
Street 23430 HAWTHORNE BLVD STE 200
City TORRANCE
State CA
ZIP 90505
Phone 310 784-5880
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 10/10/2024
Certificate Expiration Date 10/9/2026
Facility Type Physician Office
Lab Director JOHN K. CHIA MD

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