05D1063020 CLIA NUMBER - CHAEWON SONG MD INC

Laboratory Demographics

  • CLIA Code: 05D1063020
  • Facility Name: CHAEWON SONG MD INC
  • Facility Address: 12665 GARDEN GROVE BLVD #503
    GARDEN GROVE, CA
    ZIP 92843
  • Facility Phone: 714 530-3740
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: CHAEWON SONG MD
  • NPI Number: 1972589687
  • Taxonomy: 207RG0300X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1063020
LAB Type Physician Office
Facility Name CHAEWON SONG MD INC
Street 12665 GARDEN GROVE BLVD #503
City GARDEN GROVE
State CA
ZIP 92843
Phone 714 530-3740
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/3/2025
Certificate Expiration Date 1/2/2027
Facility Type Physician Office
Lab Director CHAEWON SONG MD

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