49D0667616 CLIA NUMBER - SUNG Y KIM

Laboratory Demographics

CLIA Number: 49D0667616

Facility Name: SUNG Y KIM

Facility Address:
3409 SOUTH ST
PORTSMOUTH, VA
ZIP 23707
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Facility Phone Number: 757 399-0705

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1790753762

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	49D0667616
LAB Type	Physician Office
Facility Name	SUNG Y KIM
Street	3409 SOUTH ST
City	PORTSMOUTH
State	VA
ZIP	23707
Phone	757 399-0705
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024