Provider Demographics
NPI:1164748059
Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR OF CLINICAL UROLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:OSAMU
Authorized Official - Middle Name:
Authorized Official - Last Name:UKIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PH
Authorized Official - Phone:323-865-3700
Mailing Address - Street 1:1441 EASTLAKE AVE
Mailing Address - Street 2:SUITE 7416
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-2211
Mailing Address - Country:US
Mailing Address - Phone:323-865-3700
Mailing Address - Fax:323-865-0120
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:SUITE 7416
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-2211
Practice Address - Country:US
Practice Address - Phone:323-865-3700
Practice Address - Fax:323-865-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASFP000017282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital