12D1065336 CLIA NUMBER - KELLY MEDICAL CLINIC

Laboratory Demographics

  • CLIA Code: 12D1065336
  • Facility Name: KELLY MEDICAL CLINIC
  • Facility Address: 91-2139 FORT WEAVER RD #303
    EWA BEACH, HI
    ZIP 96706
  • Facility Phone: 808 678-0700
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUSSELL S. KELLY
  • NPI Number: 1790787729
  • Taxonomy: 207R00000X - Internal Medicine

Map and Directions

Get Directions

CLIA Record

Field Name Field Value
CLIA Number 12D1065336
LAB Type Physician Office
Facility Name KELLY MEDICAL CLINIC
Street 91-2139 FORT WEAVER RD #303
City EWA BEACH
State HI
ZIP 96706
Phone 808 678-0700
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 2/27/2025
Certificate Expiration Date 2/26/2027
Facility Type Physician Office
Lab Director RUSSELL S. KELLY

Download Record

Download this CLIA record record in Text format: Export

Download this CLIA record record in Excel (CSV) format: Export

Download this CLIA record record in XML format: Export

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