05D2125283 CLIA NUMBER - ADDISON ASC, LLC

Laboratory Demographics

  • CLIA Code: 05D2125283
  • Facility Name: ADDISON ASC, LLC
  • Facility Address: 4955 VAN NUYS BLVD STE 719
    SHERMAN OAKS, CA
    ZIP 91403
  • Facility Phone: 808 325-0400
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: LARISSE K. LEE, MD
  • NPI Number: 1467903716
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2125283
LAB Type Ambulatory Surgery Center
Facility Name ADDISON ASC, LLC
Street 4955 VAN NUYS BLVD STE 719
City SHERMAN OAKS
State CA
ZIP 91403
Phone 808 325-0400
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/3/2025
Certificate Expiration Date 2/2/2027
Facility Type Ambulatory Surgery Center
Lab Director LARISSE K. LEE, MD

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