12D1106574 CLIA NUMBER - AIEA PEDIATRICS LLC

Laboratory Demographics

  • CLIA Code: 12D1106574
  • Facility Name: AIEA PEDIATRICS LLC
  • Facility Address: 99-080 KAUHALE ST C-22
    AIEA, HI
    ZIP 96701
  • Facility Phone: 808 487-1600
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: BRENT K. TAMAMOTO
  • NPI Number: 1407089808
  • Taxonomy: 208000000X - Pediatrics

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CLIA Record

Field Name Field Value
CLIA Number 12D1106574
LAB Type Physician Office
Facility Name AIEA PEDIATRICS LLC
Street 99-080 KAUHALE ST C-22
City AIEA
State HI
ZIP 96701
Phone 808 487-1600
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/16/2025
Certificate Expiration Date 10/15/2027
Facility Type Physician Office
Lab Director BRENT K. TAMAMOTO

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