CLIA lab
CLIA 05D2271479: DR Jimmy Phan Medical Corporation
Lake Elsinore, CA. Certificate and address details from the CMS Provider of Services file for clinical laboratories.
CLIA number 05D2271479 belongs to DR Jimmy Phan Medical Corporation in Lake Elsinore, CA.
Certificate of Waiver, effective November 2, 2024, expires November 1, 2026.
Active in the CMS Provider of Services file posted October 16, 2026.
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
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Certificate
- Certificate type
- Certificate of Waiver
- Certificate effective
- November 2, 2024
- Certificate expiration
- November 1, 2026
- Status in the CMS file
- Active (termination code 00)
- Original participation date
- November 2, 2022
- Facility type
- Physician office
- Ownership (control type)
- Proprietary
- Lab classification
- CLIA laboratory
Source: CMS Provider of Services File, Clinical Laboratories (CLIA), as of October 16, 2026. Publisher page
Lab and contact
- CLIA number
- 05D2271479
- Lab name
- DR Jimmy Phan Medical Corporation
- Additional name
- DBA Lake Elsinore Pediatrics
- Address
- 425 Diamond Drive Ste 103, Lake Elsinore, CA 92530
- Phone
- (951) 571-8794
- Fax
- (951) 656-1510
Annual test volume the lab reported
- Waived tests
- 50
Volumes are what the lab reported to CMS on its CMS-116 application, as carried in the file.
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- Cvs/Pharmacy #09847Certificate of Waiver, Pharmacy05D2272613
- DR Arce Family Medical Clinic IncCertificate of Waiver, Physician office05D1094975
- Farid Saadat M.D.Certificate of Waiver, Physician office05D0966075
- Healthcare Partners AffiliatesCertificate of Waiver, Physician office05D0974943
- Healthcare in Action - South RiversideCertificate of Waiver, Other05D2347920
- Lake Elsinore Clinica Medica FamiliarCertificate of Waiver, Physician office05D2029395
Related
Questions
What is the CLIA number for DR Jimmy Phan Medical Corporation in Lake Elsinore?
05D2271479, per the CMS Provider of Services file posted October 16, 2026.
What CLIA certificate does DR Jimmy Phan Medical Corporation hold?
A Certificate of Waiver, according to the CMS file.
When does CLIA 05D2271479 expire?
The CMS file lists November 1, 2026 as the certificate expiration date; the certificate took effect November 2, 2024.