Provider Demographics
NPI:1811307622
Name:LOS ANGELES USD CHDP
Entity type:Organization
Organization Name:LOS ANGELES USD CHDP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:UYEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-241-0558
Mailing Address - Street 1:333 S BEAUDRY AVE
Mailing Address - Street 2:FLOOR 29
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1466
Mailing Address - Country:US
Mailing Address - Phone:213-241-0558
Mailing Address - Fax:213-241-8458
Practice Address - Street 1:333 S BEAUDRY AVE
Practice Address - Street 2:FLOOR 29
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1466
Practice Address - Country:US
Practice Address - Phone:213-241-0558
Practice Address - Fax:213-241-8458
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS ANGELES UNIFIED SCHOOL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty