05D1039487 CLIA NUMBER - EXECUTIVE ENDOSCOPY INC ENDOSCOPY CENTER OF SAN JOSE

Laboratory Demographics

  • CLIA Code: 05D1039487
  • Facility Name: EXECUTIVE ENDOSCOPY INC ENDOSCOPY CENTER OF SAN JOSE
  • Facility Address: 2100 FOREST AVE #109
    SAN JOSE, CA
    ZIP 95128
  • Facility Phone: 408 297-2314
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DAVID CHUI
  • NPI Number: 1598815110
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1039487
LAB Type Ambulatory Surgery Center
Facility Name EXECUTIVE ENDOSCOPY INC ENDOSCOPY CENTER OF SAN JOSE
Street 2100 FOREST AVE #109
City SAN JOSE
State CA
ZIP 95128
Phone 408 297-2314
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/14/2025
Certificate Expiration Date 4/13/2027
Facility Type Ambulatory Surgery Center
Lab Director DAVID CHUI

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