05D2279189 CLIA NUMBER - OUT PT LAB

Laboratory Demographics

  • CLIA Code: 05D2279189
  • Facility Name: OUT PT LAB
  • Facility Address: 600 W BROADWAY STE 100
    GLENDALE, CA
    ZIP 91204
  • Facility Phone: 626 241-2749
  • Facility Type: Independent
  • Facility Type: Waiver
  • Lab Director: DAVID A. CHUN
  • NPI Number: 1093415812
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 05D2279189
LAB Type Independent
Facility Name OUT PT LAB
Street 600 W BROADWAY STE 100
City GLENDALE
State CA
ZIP 91204
Phone 626 241-2749
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/30/2025
Certificate Expiration Date 3/29/2027
Facility Type Independent
Lab Director DAVID A. CHUN

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