Provider Demographics
NPI:1851710883
Name:USC TELEHEALTH
Entity Type:Organization
Organization Name:USC TELEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERN/MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PLANGKLANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-821-5977
Mailing Address - Street 1:3375 S HOOVER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0116
Mailing Address - Country:US
Mailing Address - Phone:213-821-5977
Mailing Address - Fax:
Practice Address - Street 1:3375 S HOOVER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0116
Practice Address - Country:US
Practice Address - Phone:213-821-5977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management