Provider Demographics
NPI:1659424760
Name:SOUTH BAYLO UNIVERSITY
Entity Type:Organization
Organization Name:SOUTH BAYLO UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-533-1495
Mailing Address - Street 1:1126 N BROOKHURST ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1126 N BROOKHURST ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1702
Practice Address - Country:US
Practice Address - Phone:714-535-3886
Practice Address - Fax:714-535-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4649282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital