05D1104152 CLIA NUMBER - STOCKTON KIDNEY CENTER

Laboratory Demographics

  • CLIA Code: 05D1104152
  • Facility Name: STOCKTON KIDNEY CENTER
  • Facility Address: 1523 E MARCH LANE STE 200
    STOCKTON, CA
    ZIP 95210
  • Facility Phone: 209 472-3300
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: JERRY J. SOUNG MD
  • NPI Number: 1790929826
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1104152
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name STOCKTON KIDNEY CENTER
Street 1523 E MARCH LANE STE 200
City STOCKTON
State CA
ZIP 95210
Phone 209 472-3300
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 8/26/2025
Certificate Expiration Date 8/25/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director JERRY J. SOUNG MD

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