05D1068559 CLIA NUMBER - WILSON H PARK MD INC

Laboratory Demographics

  • CLIA Code: 05D1068559
  • Facility Name: WILSON H PARK MD INC
  • Facility Address: 3663 W 6TH ST # 100
    LOS ANGELES, CA
    ZIP 90020
  • Facility Phone: 213 383-4000
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: WILSON H. PARK MD
  • NPI Number: 1194855627
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1068559
LAB Type Physician Office
Facility Name WILSON H PARK MD INC
Street 3663 W 6TH ST # 100
City LOS ANGELES
State CA
ZIP 90020
Phone 213 383-4000
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/15/2025
Certificate Expiration Date 5/14/2027
Facility Type Physician Office
Lab Director WILSON H. PARK MD

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