05D1069538 CLIA NUMBER - CALIFORNIA KIDNEY MEDICAL GROUP INC

Laboratory Demographics

CLIA Number: 05D1069538

Facility Name: CALIFORNIA KIDNEY MEDICAL GROUP INC

Facility Address:
2950 SYCAMORE DR, STE 160
SIMI VALLEY, CA
ZIP 93065
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Facility Phone Number: 805 584-0177

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1831466226

Taxonomy: 251300000X - Local Education Agency (LEA)
The term local education agency means a public board of education or other public authority legally constituted within a State to either provide administrative control or direction of, or perform a service function for public schools serving individuals ages 0 - 21 in a state, city, county, township, school district, or other political subdivision including a combination of school districts or counties recognized in a State as an administrative agency for its public schools. An LEA may provide, or employ professional who provide, services to children included in the Individuals with Disabilities Education Act (IDEA), such services may include, but are not limited to, such medical services as physical, occupational, and speech therapy.

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
CertificateType	4
CertificateEffectiveDate	6/7/2023
CertificateExpirationDate	6/6/2025
FacilityType	Waiver

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