Provider Demographics
NPI:1629193081
Name:COUNTY OF LOS ANGELES
Entity Type:Organization
Organization Name:COUNTY OF LOS ANGELES
Other - Org Name:LOS ANGELES CO HARBOR UCLA N22 PHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY SERVICE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UNG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:310-222-2359
Mailing Address - Street 1:1000 WEST CARSON STREET
Mailing Address - Street 2:BOX 30
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502
Mailing Address - Country:US
Mailing Address - Phone:310-222-2359
Mailing Address - Fax:310-782-2928
Practice Address - Street 1:1000 WEST CARSON STREET
Practice Address - Street 2:PHARMACY N22
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502
Practice Address - Country:US
Practice Address - Phone:310-222-5663
Practice Address - Fax:310-222-5309
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAC HARBOR UCLA MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-21
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHE432013336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy