05D2299486 CLIA NUMBER - KINTSUGI SURGICAL II, LLC

Laboratory Demographics

  • CLIA Code: 05D2299486
  • Facility Name: KINTSUGI SURGICAL II, LLC
  • Facility Address: 1127 WILSHIRE BOULEVARD SUITE 1000C
    LOS ANGELES, CA
    ZIP 90017
  • Facility Phone: 213 328-3600
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DEREK T. DEE
  • NPI Number: 1619685153
  • Taxonomy: 261QA1903X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 05D2299486
LAB Type Ambulatory Surgery Center
Facility Name KINTSUGI SURGICAL II, LLC
Street 1127 WILSHIRE BOULEVARD SUITE 1000C
City LOS ANGELES
State CA
ZIP 90017
Phone 213 328-3600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/21/2024
Certificate Expiration Date 2/20/2026
Facility Type Ambulatory Surgery Center
Lab Director DEREK T. DEE

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