Provider Demographics
NPI:1639306798
Name:UNIVERSITY OF CALIFORNIA, LOS ANGELES
Entity Type:Organization
Organization Name:UNIVERSITY OF CALIFORNIA, LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:I
Authorized Official - Last Name:CHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:310-206-6766
Mailing Address - Street 1:DEPARTMENT OF UROLOGY 650 CHARLES YOUNG DR
Mailing Address - Street 2:BOX 951738
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-206-6766
Mailing Address - Fax:310-206-5343
Practice Address - Street 1:CLARK UROLOGY CENTER 200 MEDICAL PLZ
Practice Address - Street 2:SUITE #140
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-206-6766
Practice Address - Fax:310-206-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89934282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital