05D1069538 CLIA NUMBER - CALIFORNIA KIDNEY MEDICAL GROUP INC

Laboratory Demographics

  • CLIA Code: 05D1069538
  • Facility Name: CALIFORNIA KIDNEY MEDICAL GROUP INC
  • Facility Address: 2950 SYCAMORE DR, STE 160
    SIMI VALLEY, CA
    ZIP 93065
  • Facility Phone: 805 584-0177
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: JIESHI YAN
  • NPI Number: 1831466226
  • Taxonomy: 251300000X - Local Education Agency (LEA)

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CLIA Record

Field Name Field Value
CLIA Number 05D1069538
LAB Type Physician Office
Facility Name CALIFORNIA KIDNEY MEDICAL GROUP INC
Street 2950 SYCAMORE DR, STE 160
City SIMI VALLEY
State CA
ZIP 93065
Phone 805 584-0177
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/7/2025
Certificate Expiration Date 6/6/2027
Facility Type Physician Office
Lab Director JIESHI YAN

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