12D2098373 CLIA NUMBER - ISLAND UROLOGY OAHU LLC

Laboratory Demographics

  • CLIA Code: 12D2098373
  • Facility Name: ISLAND UROLOGY OAHU LLC
  • Facility Address: 670 PONAHAWAI ST STE 217
    HILO, HI
    ZIP 96720
  • Facility Phone: 808 536-2306
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: SERGEI TIKHONENKOV
  • NPI Number: 1053592147
  • Taxonomy: 208800000X - Urology

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CLIA Record

Field Name Field Value
CLIA Number 12D2098373
LAB Type Physician Office
Facility Name ISLAND UROLOGY OAHU LLC
Street 670 PONAHAWAI ST STE 217
City HILO
State HI
ZIP 96720
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 7/6/2025
Certificate Expiration Date 7/5/2027
Facility Type Physician Office
Lab Director SERGEI TIKHONENKOV

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