05D2076999 CLIA NUMBER - GRAND ENDOSCOPY CENTER

Laboratory Demographics

  • CLIA Code: 05D2076999
  • Facility Name: GRAND ENDOSCOPY CENTER
  • Facility Address: 505 S VIRGIL AVE # 104
    LOS ANGELES, CA
    ZIP 90020
  • Facility Phone: 213 381-3590
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DAE S. RHEEM, MD
  • NPI Number: 1871914291
  • Taxonomy: 261QE0800X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2076999
LAB Type Ambulatory Surgery Center
Facility Name GRAND ENDOSCOPY CENTER
Street 505 S VIRGIL AVE # 104
City LOS ANGELES
State CA
ZIP 90020
Phone 213 381-3590
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 4/30/2024
Certificate Expiration Date 4/29/2026
Facility Type Ambulatory Surgery Center
Lab Director DAE S. RHEEM, MD

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