14D2106734 CLIA NUMBER - BRIDGEPORT FREE CLINIC

Laboratory Demographics

  • CLIA Code: 14D2106734
  • Facility Name: BRIDGEPORT FREE CLINIC
  • Facility Address: 3000 S WALLACE ST
    CHICAGO, IL
    ZIP 60616
  • Facility Phone: 773 834-4042
  • Facility Type: Other - VOLUNTEER MD FREE CLINIC
  • Facility Type: Waiver
  • Lab Director: KAREN E. KIM MD
  • NPI Number: 1437376803
  • Taxonomy: 213E00000X - Podiatrist

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CLIA Record

Field Name Field Value
CLIA Number 14D2106734
LAB Type Other - VOLUNTEER MD FREE CLINIC
Facility Name BRIDGEPORT FREE CLINIC
Street 3000 S WALLACE ST
City CHICAGO
State IL
ZIP 60616
Phone 773 834-4042
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 12/28/2023
Certificate Expiration Date 12/27/2025
Facility Type Other - VOLUNTEER MD FREE CLINIC
Lab Director KAREN E. KIM MD

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