Provider Demographics
NPI:1144578774
Name:UNIVERSITY OF CALIFORNIA LOS ANGELES
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VISITING ASSISTANT RESEARCHER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAIGO
Authorized Official - Middle Name:
Authorized Official - Last Name:YAGISHITA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-709-9379
Mailing Address - Street 1:11734 WILSHIRE BLVD., C703
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 CHARLES E. YOUNG DRIVE SOUTH
Practice Address - Street 2:100 UCLA MEDICAL PLAZA, SUITE 660
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-709-9379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory