05D2163036 CLIA NUMBER - GARDENA DIALYSIS

Laboratory Demographics

  • CLIA Code: 05D2163036
  • Facility Name: GARDENA DIALYSIS
  • Facility Address: 1201 W 155TH STREET
    GARDENA, CA
    ZIP 90247
  • Facility Phone: 310 538-6804
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: MARJAN CHEGOUNCHI
  • NPI Number: 1710477914
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2163036
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name GARDENA DIALYSIS
Street 1201 W 155TH STREET
City GARDENA
State CA
ZIP 90247
Phone 310 538-6804
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2025
Certificate Expiration Date 3/5/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director MARJAN CHEGOUNCHI

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