12D2277827 CLIA NUMBER - DR RUSSELL M TOM LLC

Laboratory Demographics

  • CLIA Code: 12D2277827
  • Facility Name: DR RUSSELL M TOM LLC
  • Facility Address: 98-1079 MOANALUA RD, SUITE 350B
    AIEA, HI
    ZIP 96701
  • Facility Phone: (808) 487-2277
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: RUSSELL M. TOM
  • NPI Number: 1346258407
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 12D2277827
LAB Type Physician Office
Facility Name DR RUSSELL M TOM LLC
Street 98-1079 MOANALUA RD, SUITE 350B
City AIEA
State HI
ZIP 96701
Phone 8084872277
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 3/6/2025
Certificate Expiration Date 3/5/2027
Facility Type Physician Office
Lab Director RUSSELL M. TOM

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This page was last updated on: 5/18/2026