Provider Demographics
NPI:1336292853
Name:UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR OF SURGERY
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-476-6359
Mailing Address - Street 1:4 KORET WAY, LR-101, BOX 0475
Mailing Address - Street 2:UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0475
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 PARNASSUS AVE, A-655
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0338
Practice Address - Country:US
Practice Address - Phone:415-353-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG8643261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy