Basic Information
| Provider Information | |||||||||
| NPI: | 1164748059 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF SOUTHERN CALIFORNIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1441 EASTLAKE AVE | ||||||||
| Address2: | SUITE 7416 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900892211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238653700 | ||||||||
| FaxNumber: | 3238650120 | ||||||||
| Practice Location | |||||||||
| Address1: | 1441 EASTLAKE AVE | ||||||||
| Address2: | SUITE 7416 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900892211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238653700 | ||||||||
| FaxNumber: | 3238650120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2010 | ||||||||
| LastUpdateDate: | 04/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | UKIMURA | ||||||||
| AuthorizedOfficialFirstName: | OSAMU | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROFESSOR OF CLINICAL UROLOGY | ||||||||
| AuthorizedOfficialTelephone: | 3238653700 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D.,PH. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | SFP000017 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.