05D2145845 CLIA NUMBER - KELLEY PARK MEDICAL CLINIC INC - PETER L NGUYEN DO

Laboratory Demographics

CLIA Number: 05D2145845

Facility Name: KELLEY PARK MEDICAL CLINIC INC - PETER L NGUYEN DO

Facility Address:
749 STORY RD STE 20
SAN JOSE, CA
ZIP 95122
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Facility Phone Number: 408 794-2088

Facility Type: Physician Office

Certificate Type: Microscopy

NPI Number: 1942340625

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2145845
LAB Type	Physician Office
Facility Name	KELLEY PARK MEDICAL CLINIC INC - PETER L NGUYEN DO
Street	749 STORY RD STE 20
City	SAN JOSE
State	CA
ZIP	95122
Phone	408 794-2088
CertificateType	3
CertificateEffectiveDate	3/16/2024
CertificateExpirationDate	3/15/2026
FacilityType	PPMP

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This page was last updated on: 4/23/2024