05D2317389 CLIA NUMBER - KOUROSH KHAMOOSHIAN MD, PC DBA KHAMOOSHIAN WELLHAVEN MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 05D2317389
  • Facility Name: KOUROSH KHAMOOSHIAN MD, PC DBA KHAMOOSHIAN WELLHAVEN MEDICAL CLINIC
  • Facility Address: 5555 RESERVOIR DR STE 303
    SAN DIEGO, CA
    ZIP 92120
  • Facility Phone: 858 373-9615
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: KOUROSH KHAMOOSHIAN
  • NPI Number: 1659523975
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 05D2317389
LAB Type Physician Office
Facility Name KOUROSH KHAMOOSHIAN MD, PC DBA KHAMOOSHIAN WELLHAVEN MEDICAL CLINIC
Street 5555 RESERVOIR DR STE 303
City SAN DIEGO
State CA
ZIP 92120
Phone 858 373-9615
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/23/2025
Certificate Expiration Date 1/22/2027
Facility Type Physician Office
Lab Director KOUROSH KHAMOOSHIAN

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