Provider Demographics
NPI: | 1164512851 |
---|---|
Name: | UNIVERSITY OF CALIFORNIA SAN FRANCISCO |
Entity Type: | Organization |
Organization Name: | UNIVERSITY OF CALIFORNIA SAN FRANCISCO |
Other - Org Name: | UCSF MEDICAL CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VICE PRESIDENT, MEDICAL STAFF GOV |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KOSAL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 415-353-7235 |
Mailing Address - Street 1: | 2001 THE EMBARCADERO STE 1500 |
Mailing Address - Street 2: | |
Mailing Address - City: | SAN FRANCISCO |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94143-5200 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 415-885-7268 |
Mailing Address - Fax: | 415-885-7445 |
Practice Address - Street 1: | 400 PARNASSUS AVE |
Practice Address - Street 2: | |
Practice Address - City: | SAN FRANCISCO |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94143-2202 |
Practice Address - Country: | US |
Practice Address - Phone: | 415-476-1000 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | UNIVERSITY OF CALIFORNIA SAN FRANCISCO MEDICAL CENTER |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-10-13 |
Last Update Date: | 2023-06-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 220000091 | 207N00000X, 207R00000X, 207RC0000X, 207RE0101X, 207RG0100X, 207RH0000X, 207RI0200X, 207RN0300X, 207V00000X, 207X00000X, 207ZC0006X, 208000000X, 2084N0400X, 2085R0202X, 208600000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RH0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207ZC0006X | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CA | GR008429B | Medicaid | |
CA | ZZZ15253Z | Medicare ID - Type Unspecified | |
CA | 220000091 | Medicare PIN |