05D0930212 CLIA NUMBER - MB DERMATOLOGY AND COSMETIC SURGERY

Laboratory Demographics

  • CLIA Code: 05D0930212
  • Facility Name: MB DERMATOLOGY AND COSMETIC SURGERY
  • Facility Address: 14650 AVIATION BLVD STE 235
    HAWTHORNE, CA
    ZIP 90250
  • Facility Phone: 310 643-9333
  • Facility Type: Physician Office
  • Facility Type: Certificate of Compliance
  • Lab Director: JAMES G. WU
  • NPI Number: 1407029069
  • Taxonomy: 207N00000X - Dermatology

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CLIA Record

Field Name Field Value
CLIA Number 05D0930212
LAB Type Physician Office
Facility Name MB DERMATOLOGY AND COSMETIC SURGERY
Street 14650 AVIATION BLVD STE 235
City HAWTHORNE
State CA
ZIP 90250
Phone 310 643-9333
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 2/17/2022
Certificate Expiration Date 6/30/2025
Facility Type Physician Office
Lab Director JAMES G. WU

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