05D2230213 CLIA NUMBER - USC KOREA TOWN HOME DIALYSIS

Laboratory Demographics

CLIA Number: 05D2230213

Facility Name: USC KOREA TOWN HOME DIALYSIS

Facility Address:
3660 WILSHIRE BLVD, STE 338
LOS ANGELES, CA
ZIP 90010
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Facility Phone Number: 213 900-1415

Facility Type: End Stage Renal Disease Dialysis Facility

Certificate Type: Waiver

NPI Number: 1376118281

Taxonomy: 261QE0700X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	05D2230213
LAB Type	End Stage Renal Disease Dialysis Facility
Facility Name	USC KOREA TOWN HOME DIALYSIS
Street	3660 WILSHIRE BLVD, STE 338
City	LOS ANGELES
State	CA
ZIP	90010
Phone	213 900-1415
CertificateType	4
CertificateEffectiveDate	7/21/2023
CertificateExpirationDate	7/20/2025
FacilityType	Waiver

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