05D2306710 CLIA NUMBER - SANTA MONICA DETOX LLC

Laboratory Demographics

  • CLIA Code: 05D2306710
  • Facility Name: SANTA MONICA DETOX LLC
  • Facility Address: 729 17TH STREET
    SANTA MONICA, CA
    ZIP 90402
  • Facility Phone: 213 205-8221
  • Facility Type: Other - RESIDENTIAL DRUG TRMT CTR
  • Facility Type: Waiver
  • Lab Director: JONG KIM
  • NPI Number: 1720859341
  • Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility

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CLIA Record

Field Name Field Value
CLIA Number 05D2306710
LAB Type Other - RESIDENTIAL DRUG TRMT CTR
Facility Name SANTA MONICA DETOX LLC
Street 729 17TH STREET
City SANTA MONICA
State CA
ZIP 90402
Phone 213 205-8221
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/24/2024
Certificate Expiration Date 6/23/2026
Facility Type Other - RESIDENTIAL DRUG TRMT CTR
Lab Director JONG KIM

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