Provider Demographics
NPI:1225103427
Name:VALLEY CARE OVMC UCLA
Entity Type:Organization
Organization Name:VALLEY CARE OVMC UCLA
Other - Org Name:DHS COUNTY OF LOS ANGELES
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MUN
Authorized Official - Middle Name:KOON
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-364-4301
Mailing Address - Street 1:14445 OLIVE VIEW MEDICAL CENTER
Mailing Address - Street 2:OLIVE VIEW DRIVE
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DRIVE
Practice Address - Street 2:COMMUNITY HEALTH PLAN CLINIC ADULT
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342
Practice Address - Country:US
Practice Address - Phone:818-364-4301
Practice Address - Fax:818-364-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44113261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
101713Medicare UPIN