Provider Demographics
NPI:1417931387
Name:UNIVERSITY OF CALIFORNIA, DAVIS
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, DAVIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROFESSOR OF CLINICAL MED
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ASMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-734-8695
Mailing Address - Street 1:5709 THAMES WAY
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-5556
Mailing Address - Country:US
Mailing Address - Phone:916-487-9317
Mailing Address - Fax:
Practice Address - Street 1:4150 V ST
Practice Address - Street 2:PSSB G500
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1460
Practice Address - Country:US
Practice Address - Phone:916-734-8695
Practice Address - Fax:916-734-7766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G865750282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G865750OtherMEDI-CAL
CA00G865750Medicare ID - Type Unspecified
CA00G865750OtherMEDI-CAL