Provider Demographics
NPI:1992831655
Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:SIMHAI
Authorized Official - Last Name:YOUNAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-825-8879
Mailing Address - Street 1:10833 LE CONTE AVE BOX 951668
Mailing Address - Street 2:RM A0-125CHS
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1668
Mailing Address - Country:US
Mailing Address - Phone:310-825-8879
Mailing Address - Fax:310-825-2124
Practice Address - Street 1:10833 LE CONTE AVE BOX 951668
Practice Address - Street 2:RM A0-125CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-8879
Practice Address - Fax:310-794-9723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20751223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWD45421AMedicare PIN
CAWD47393BMedicare PIN
CAW14332Medicare PIN
CAWD23937BMedicare PIN