05D1106763 CLIA NUMBER - ALTAMED MEDICAL GROUP-GARDEN GROVE HARBOR

Laboratory Demographics

  • CLIA Code: 05D1106763
  • Facility Name: ALTAMED MEDICAL GROUP-GARDEN GROVE HARBOR
  • Facility Address: 12751 HARBOR BLVD
    GARDEN GROVE, CA
    ZIP 92840
  • Facility Phone: 714 636-7852
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: EDWARD KO MD
  • NPI Number: 1083851992
  • Taxonomy: 261QC1500X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D1106763
LAB Type Community Clinic
Facility Name ALTAMED MEDICAL GROUP-GARDEN GROVE HARBOR
Street 12751 HARBOR BLVD
City GARDEN GROVE
State CA
ZIP 92840
Phone 714 636-7852
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/21/2025
Certificate Expiration Date 10/20/2027
Facility Type Community Clinic
Lab Director EDWARD KO MD

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