05D1088257 CLIA NUMBER - KENNETH B MAYBURY, MD

Laboratory Demographics

  • CLIA Code: 05D1088257
  • Facility Name: KENNETH B MAYBURY, MD
  • Facility Address: 2250 HAYES ST STE 504
    SAN FRANCISCO, CA
    ZIP 94117
  • Facility Phone: 415 422-0998
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KENNETH B. MAYBURY
  • NPI Number: 1295733459
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D1088257
LAB Type Physician Office
Facility Name KENNETH B MAYBURY, MD
Street 2250 HAYES ST STE 504
City SAN FRANCISCO
State CA
ZIP 94117
Phone 415 422-0998
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2024
Certificate Expiration Date 10/15/2026
Facility Type Physician Office
Lab Director KENNETH B. MAYBURY

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