05D2120979 CLIA NUMBER - KENNETH RUSS, MD

Laboratory Demographics

  • CLIA Code: 05D2120979
  • Facility Name: KENNETH RUSS, MD
  • Facility Address: 7885 ANNADALE AVE
    DESERT HOT SPRINGS, CA
    ZIP 92240
  • Facility Phone: 760 416-6773
  • Facility Type: Other - TREATMENT FACILITY
  • Facility Type: Waiver
  • Lab Director: KENNETH RUSS, MD
  • NPI Number: 1245258235
  • Taxonomy: 207QA0401X - Family Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 05D2120979
LAB Type Other - TREATMENT FACILITY
Facility Name KENNETH RUSS, MD
Street 7885 ANNADALE AVE
City DESERT HOT SPRINGS
State CA
ZIP 92240
Phone 760 416-6773
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/27/2024
Certificate Expiration Date 10/26/2026
Facility Type Other - TREATMENT FACILITY
Lab Director KENNETH RUSS, MD

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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