Basic Information
| Provider Information | |||||||||
| NPI: | 1790945467 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERISTY OF CALIFORNIA SAN DIEGO MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9500 GILMAN DR | ||||||||
| Address2: | UCSD MC0726 | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920935004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588226583 | ||||||||
| FaxNumber: | 8588226444 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 W ARBOR DR | ||||||||
| Address2: | UCSD MEDICAL CENTER | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921039001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883098273 | ||||||||
| FaxNumber: | 6195433183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2008 | ||||||||
| LastUpdateDate: | 06/16/2008 | ||||||||
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| AuthorizedOfficialLastName: | GO | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | YAN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 8588226583 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D., PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | A101688 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | 282N00000X | A101688 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.