05D2112521 CLIA NUMBER - 123 MEDICAL GROUP CORP

Laboratory Demographics

  • CLIA Code: 05D2112521
  • Facility Name: 123 MEDICAL GROUP CORP
  • Facility Address: 18800 AMAR RD STE C-12
    WALNUT, CA
    ZIP 91789
  • Facility Phone: 626 788-9691
  • Facility Type: Community Clinic
  • Facility Type: Waiver
  • Lab Director: THOMAS T. LEE
  • NPI Number: 1588029771
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2112521
LAB Type Community Clinic
Facility Name 123 MEDICAL GROUP CORP
Street 18800 AMAR RD STE C-12
City WALNUT
State CA
ZIP 91789
Phone 626 788-9691
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/2/2024
Certificate Expiration Date 5/1/2026
Facility Type Community Clinic
Lab Director THOMAS T. LEE

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This page was last updated on: 3/20/2025