05D2210233 CLIA NUMBER - STACY MEDICAL CENTER, INC

Laboratory Demographics

  • CLIA Code: 05D2210233
  • Facility Name: STACY MEDICAL CENTER, INC
  • Facility Address: 4580 PACIFIC BLVD
    VERNON, CA
    ZIP 90058
  • Facility Phone: 323 584-0779
  • Facility Type: Practitioner Other
  • Facility Type: Waiver
  • Lab Director: PAUL SEUNG KIM
  • NPI Number: 1861830648
  • Taxonomy: 208D00000X - General Practice

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CLIA Record

Field Name Field Value
CLIA Number 05D2210233
LAB Type Practitioner Other
Facility Name STACY MEDICAL CENTER, INC
Street 4580 PACIFIC BLVD
City VERNON
State CA
ZIP 90058
Phone 323 584-0779
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/20/2025
Certificate Expiration Date 1/19/2027
Facility Type Practitioner Other
Lab Director PAUL SEUNG KIM

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