05D0963221 CLIA NUMBER - MEMORIAL CARE MEDICAL FOUNDATION

Laboratory Demographics

  • CLIA Code: 05D0963221
  • Facility Name: MEMORIAL CARE MEDICAL FOUNDATION
  • Facility Address: 17762 BEACH BLVD, STE 220
    HUNTINGTON BEACH, CA
    ZIP 92647
  • Facility Phone: 714 848-0080
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: VINH NGUYEN MD
  • NPI Number: 1073664504
  • Taxonomy: 261QP2300X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D0963221
LAB Type Physician Office
Facility Name MEMORIAL CARE MEDICAL FOUNDATION
Street 17762 BEACH BLVD, STE 220
City HUNTINGTON BEACH
State CA
ZIP 92647
Phone 714 848-0080
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 8/21/2025
Certificate Expiration Date 8/20/2027
Facility Type Physician Office
Lab Director VINH NGUYEN MD

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