Provider Demographics
NPI:1669790812
Name:USC DEPARTMENT OF SURGERY
Entity type:Organization
Organization Name:USC DEPARTMENT OF SURGERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIVISION CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAGEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-442-9058
Mailing Address - Street 1:1510 SAN PABLO ST
Mailing Address - Street 2:SUITE 514
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5320
Mailing Address - Country:US
Mailing Address - Phone:323-442-9058
Mailing Address - Fax:323-442-5803
Practice Address - Street 1:1510 SAN PABLO ST
Practice Address - Street 2:SUITE 514
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5320
Practice Address - Country:US
Practice Address - Phone:323-442-9058
Practice Address - Fax:323-442-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF 5615284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital