Provider Demographics
NPI:1790945467
Name:UNIVERISTY OF CALIFORNIA SAN DIEGO MEDICAL CENTER
Entity Type:Organization
Organization Name:UNIVERISTY OF CALIFORNIA SAN DIEGO MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:YAN
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:858-822-6583
Mailing Address - Street 1:9500 GILMAN DR
Mailing Address - Street 2:UCSD MC0726
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-5004
Mailing Address - Country:US
Mailing Address - Phone:858-822-6583
Mailing Address - Fax:858-822-6444
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:UCSD MEDICAL CENTER
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:888-309-8273
Practice Address - Fax:619-543-3183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101688261QM2500X, 282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty