05D0938704 CLIA NUMBER - PENINSULA PEDIATRIC MEDICAL GROUP AFFILIATE OF PACKARD CHILDREN'S HEALTH ALLIANCE

Laboratory Demographics

  • CLIA Code: 05D0938704
  • Facility Name: PENINSULA PEDIATRIC MEDICAL GROUP AFFILIATE OF PACKARD CHILDREN'S HEALTH ALLIANCE
  • Facility Address: 1720 EL CAMINO REAL, STE 205
    BURLINGAME, CA
    ZIP 94010
  • Facility Phone: 650 259-5050
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JEFFREY T. TAN, MD
  • NPI Number: 1578778197
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 05D0938704
LAB Type Physician Office
Facility Name PENINSULA PEDIATRIC MEDICAL GROUP AFFILIATE OF PACKARD CHILDREN'S HEALTH ALLIANCE
Street 1720 EL CAMINO REAL, STE 205
City BURLINGAME
State CA
ZIP 94010
Phone 650 259-5050
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/13/2024
Certificate Expiration Date 1/12/2026
Facility Type Physician Office
Lab Director JEFFREY T. TAN, MD

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