Provider Demographics
NPI:1417968413
Name:CITY OF HOPE MEDICAL FOUNDATION
Entity Type:Organization
Organization Name:CITY OF HOPE MEDICAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-256-4673
Mailing Address - Street 1:PO BOX 512185
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-0185
Mailing Address - Country:US
Mailing Address - Phone:626-775-3200
Mailing Address - Fax:
Practice Address - Street 1:1043 ELM AVE
Practice Address - Street 2:STE 104
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3271
Practice Address - Country:US
Practice Address - Phone:562-590-0345
Practice Address - Fax:562-437-8139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0065540Medicaid
CAGR0065540Medicaid
CA1118450001Medicare NSC