Provider Demographics
NPI:1619935251
Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:UCLA HEAD & NECK ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:SACHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-825-5741
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:SUITE 550
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-203-3388
Practice Address - Fax:310-301-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066320Medicaid
CAW13592Medicare ID - Type Unspecified