05D2161614 CLIA NUMBER - CARSON PAVILION DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2161614
  • Facility Name: CARSON PAVILION DIALYSIS
  • Facility Address: 20930 CHICO STREET
    CARSON, CA
    ZIP 90746
  • Facility Phone: 530 892-9937
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: PHILLIP CHUNG
  • NPI Number: 1912497116
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2161614
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name CARSON PAVILION DIALYSIS
Street 20930 CHICO STREET
City CARSON
State CA
ZIP 90746
Phone 530 892-9937
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/6/2025
Certificate Expiration Date 2/5/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director PHILLIP CHUNG

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