12D2086052 CLIA NUMBER - ISLAND UROLOGY OAHU LLC

Laboratory Demographics

  • CLIA Code: 12D2086052
  • Facility Name: ISLAND UROLOGY OAHU LLC
  • Facility Address: 1329 LUSITANA ST SUITE 706
    HONOLULU, HI
    ZIP 96813
  • Facility Phone: 808 536-2306
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SERGEI TIKHONENKOV
  • NPI Number: 1962683052
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 12D2086052
LAB Type Physician Office
Facility Name ISLAND UROLOGY OAHU LLC
Street 1329 LUSITANA ST SUITE 706
City HONOLULU
State HI
ZIP 96813
Phone 808 536-2306
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/3/2025
Certificate Expiration Date 6/2/2027
Facility Type Physician Office
Lab Director SERGEI TIKHONENKOV

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