49D1015687 CLIA NUMBER - FAIRFAX FAMILY MEDICINE CENTER

Laboratory Demographics

  • CLIA Code: 49D1015687
  • Facility Name: FAIRFAX FAMILY MEDICINE CENTER
  • Facility Address: 10801 MAIN STREET - SUITE 700
    FAIRFAX, VA
    ZIP 22030
  • Facility Phone: 703 591-4100
  • Facility Type: Physician Office
  • Facility Type: Microscopy
  • Lab Director: MICHAEL D. KIM
  • NPI Number: 1437468311
  • Taxonomy: 207R00000X - Internal Medicine

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CLIA Record

Field Name Field Value
CLIA Number 49D1015687
LAB Type Physician Office
Facility Name FAIRFAX FAMILY MEDICINE CENTER
Street 10801 MAIN STREET - SUITE 700
City FAIRFAX
State VA
ZIP 22030
Phone 703 591-4100
Certificate Type Certificate for Provider-Performed Microscopy Procedures (PPMP)
Certificate Type Description This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.
Certificate Effective Date 8/12/2025
Certificate Expiration Date 8/11/2027
Facility Type Physician Office
Lab Director MICHAEL D. KIM

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