Provider Demographics
NPI:1922018977
Name:USC HEAD & NECK GROUP, INC
Entity Type:Organization
Organization Name:USC HEAD & NECK GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE PLAN ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:UDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-442-5827
Mailing Address - Street 1:1520 SAN PABLO ST
Mailing Address - Street 2:SUITE 4600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5310
Mailing Address - Country:US
Mailing Address - Phone:323-442-5790
Mailing Address - Fax:323-442-5820
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 4600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5790
Practice Address - Fax:323-442-5820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0056450Medicaid
CAW12025Medicare ID - Type Unspecified