Provider Demographics
NPI:1518193739
Name:CALIFORNIA STATE UNIVERSITY, LOS ANGELES STUDENT HEALTH CENTER
Entity Type:Organization
Organization Name:CALIFORNIA STATE UNIVERSITY, LOS ANGELES STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-343-3310
Mailing Address - Street 1:5151 STATE UNIVERSITY DR
Mailing Address - Street 2:STUDENT HEALTH CENTER (SHC)
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-4226
Mailing Address - Country:US
Mailing Address - Phone:323-343-3303
Mailing Address - Fax:
Practice Address - Street 1:5151 STATE UNIVERSITY DR
Practice Address - Street 2:STUDENT HEALTH CENTER (SHC)
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-4226
Practice Address - Country:US
Practice Address - Phone:323-343-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health