21D2105353 CLIA NUMBER - ODENTON DIALYSIS

Laboratory Demographics

  • CLIA Code: 21D2105353
  • Facility Name: ODENTON DIALYSIS
  • Facility Address: 1360 BLAIR DR STE L & M
    ODENTON, MD
    ZIP 21113
  • Facility Phone: 410 674-3918
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KENNETH YIM
  • NPI Number: 1699159228
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 21D2105353
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name ODENTON DIALYSIS
Street 1360 BLAIR DR STE L & M
City ODENTON
State MD
ZIP 21113
Phone 410 674-3918
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/23/2023
Certificate Expiration Date 11/22/2025
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director KENNETH YIM

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