14D0997375 CLIA NUMBER - ASIAN VILLAGE MEDICAL CLINIC PC

Laboratory Demographics

CLIA Number: 14D0997375

Facility Name: ASIAN VILLAGE MEDICAL CLINIC PC

Facility Address:
5129 NORTH BROADWAY SUITE E
CHICAGO, IL
ZIP 60640
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Facility Phone Number: (773) 275-4250

Facility Type: PHYSICIAN OFFICE

Certificate Type: Waiver

NPI Number: 1548436892

Taxonomy: 261Q00000X - Clinic/Center
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).

CLIA Record

Field Name	Field Value
CLIA Number	14D0997375
LAB Type	PHYSICIAN OFFICE
Facility Name	ASIAN VILLAGE MEDICAL CLINIC PC
Street	5129 NORTH BROADWAY SUITE E
City	CHICAGO
State	IL
ZIP	60640
Phone	(773) 275-4250

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This page was last updated on: 5/11/2023