49D2097241 CLIA NUMBER - DALE CITY DIALYSIS

Laboratory Demographics

  • CLIA Code: 49D2097241
  • Facility Name: DALE CITY DIALYSIS
  • Facility Address: 2920 DALE BOULEVARD
    DALE CITY, VA
    ZIP 22193
  • Facility Phone: 703 680-5837
  • Facility Type: End Stage Renal Disease Dialysis Facility
  • Facility Type: Waiver
  • Lab Director: KOUROSH DIBADJ
  • NPI Number: 1639561780
  • Taxonomy: 261QE0700X - Clinic/Center

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CLIA Record

Field Name Field Value
CLIA Number 49D2097241
LAB Type End Stage Renal Disease Dialysis Facility
Facility Name DALE CITY DIALYSIS
Street 2920 DALE BOULEVARD
City DALE CITY
State VA
ZIP 22193
Phone 703 680-5837
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 6/10/2025
Certificate Expiration Date 6/9/2027
Facility Type End Stage Renal Disease Dialysis Facility
Lab Director KOUROSH DIBADJ

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