05D1058034 CLIA NUMBER - MINA SEHHAT MD

Laboratory Demographics

CLIA Number: 05D1058034

Facility Name: MINA SEHHAT MD

Facility Address:
2101 FOREST AVENUE, SUITE 104
SAN JOSE, CA
ZIP 95128
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Facility Phone Number: 408 975-7680

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1558393314

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	05D1058034
LAB Type	Physician Office
Facility Name	MINA SEHHAT MD
Street	2101 FOREST AVENUE, SUITE 104
City	SAN JOSE
State	CA
ZIP	95128
Phone	408 975-7680
CertificateType	4
CertificateEffectiveDate	8/28/2022
CertificateExpirationDate	8/27/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024