05D2113704 CLIA NUMBER - SOUTH BAY SUNSET PAVILION

Laboratory Demographics

  • CLIA Code: 05D2113704
  • Facility Name: SOUTH BAY SUNSET PAVILION
  • Facility Address: 1565 GULF AVE
    WILMINGTON, CA
    ZIP 90744
  • Facility Phone: 310 462-4942
  • Facility Type: Other - CLHF
  • Facility Type: Waiver
  • Lab Director: SITTIPORN BOONTUNG, MD
  • NPI Number: 1356849061
  • Taxonomy: 314000000X - Skilled Nursing Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2113704
LAB Type Other - CLHF
Facility Name SOUTH BAY SUNSET PAVILION
Street 1565 GULF AVE
City WILMINGTON
State CA
ZIP 90744
Phone 310 462-4942
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/27/2024
Certificate Expiration Date 5/26/2026
Facility Type Other - CLHF
Lab Director SITTIPORN BOONTUNG, MD

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