05D1024936 CLIA NUMBER - FOOTHILL GATEWAY SURGERY CENTER LLC

Laboratory Demographics

  • CLIA Code: 05D1024936
  • Facility Name: FOOTHILL GATEWAY SURGERY CENTER LLC
  • Facility Address: 29300 PORTOLA PARKWAY SUITE A
    LAKE FOREST, CA
    ZIP 92630
  • Facility Phone: 949 305-3913
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: STEPHEN KIM, MD
  • NPI Number: 1104985910
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1024936
LAB Type Ambulatory Surgery Center
Facility Name FOOTHILL GATEWAY SURGERY CENTER LLC
Street 29300 PORTOLA PARKWAY SUITE A
City LAKE FOREST
State CA
ZIP 92630
Phone 949 305-3913
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/26/2024
Certificate Expiration Date 4/25/2026
Facility Type Ambulatory Surgery Center
Lab Director STEPHEN KIM, MD

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