05D2125515 CLIA NUMBER - PETER H PARK, M.D., INC.

Laboratory Demographics

  • CLIA Code: 05D2125515
  • Facility Name: PETER H PARK, M.D., INC.
  • Facility Address: 3456 W OLYMPIC BLVD, STE 101
    LOS ANGELES, CA
    ZIP 90019
  • Facility Phone: 323 840-3960
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: PETER H. PARK
  • NPI Number: 1225076516
  • Taxonomy: 174400000X - Specialist

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CLIA Record

Field Name Field Value
CLIA Number 05D2125515
LAB Type Physician Office
Facility Name PETER H PARK, M.D., INC.
Street 3456 W OLYMPIC BLVD, STE 101
City LOS ANGELES
State CA
ZIP 90019
Phone 323 840-3960
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/8/2025
Certificate Expiration Date 2/7/2027
Facility Type Physician Office
Lab Director PETER H. PARK

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