12D2316602 CLIA NUMBER - IVEY PLASTIC SURGERY

Laboratory Demographics

  • CLIA Code: 12D2316602
  • Facility Name: IVEY PLASTIC SURGERY
  • Facility Address: 411 HUKU LII PL, SUITE 303
    KIHEI, HI
    ZIP 96753
  • Facility Phone: 808 500-5146
  • Facility Type: Ambulatory Surgery Center
  • Facility Type: Waiver
  • Lab Director: DR. JON S. IVEY
  • NPI Number: 1205427861
  • Taxonomy: 208200000X - Plastic Surgery

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CLIA Record

Field Name Field Value
CLIA Number 12D2316602
LAB Type Ambulatory Surgery Center
Facility Name IVEY PLASTIC SURGERY
Street 411 HUKU LII PL, SUITE 303
City KIHEI
State HI
ZIP 96753
Phone 808 500-5146
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 1/8/2025
Certificate Expiration Date 1/7/2027
Facility Type Ambulatory Surgery Center
Lab Director DR. JON S. IVEY

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