05D2155031 CLIA NUMBER - INTERCOMMUNITY DIALYSIS CENTER - LA MIRADA

Laboratory Demographics

  • CLIA Code: 05D2155031
  • Facility Name: INTERCOMMUNITY DIALYSIS CENTER - LA MIRADA
  • Facility Address: 15060 IMPERIAL HIGHWAY
    LA MIRADA, CA
    ZIP 90638
  • Facility Phone: 562 469-5615
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KEVIN HUANG
  • NPI Number: 1114461043
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2155031
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name INTERCOMMUNITY DIALYSIS CENTER - LA MIRADA
Street 15060 IMPERIAL HIGHWAY
City LA MIRADA
State CA
ZIP 90638
Phone 562 469-5615
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 9/21/2024
Certificate Expiration Date 9/20/2026
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director KEVIN HUANG

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