Provider Demographics
NPI:1841724168
Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:UNIVERSITY OF SOUTHERN CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PROVOST ACADEMIC OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:K
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-821-4400
Mailing Address - Street 1:925 W. 34TH STREET
Mailing Address - Street 2:DEN B23
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-2212
Mailing Address - Country:US
Mailing Address - Phone:213-740-1637
Mailing Address - Fax:213-740-8663
Practice Address - Street 1:545 S. SAN PEDRO STREET
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2101
Practice Address - Country:US
Practice Address - Phone:213-347-6300
Practice Address - Fax:213-673-4582
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF SOUTHERN CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-13
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty