MEDICARE: UNIVERSITY OF SOUTHERN CALIFORNIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	SFP000017	CA

General Provider Information

NPI Number	:	1164748059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF SOUTHERN CALIFORNIA

Provider Business Mailing Address
First Line	:	1441 EASTLAKE AVE
Second Line	:	SUITE 7416
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-2211
Country	:	US
Telephone Number	:	323-865-3700
Fax Number	:	323-865-0120

Provider Business Practice Location Address
First Line	:	1441 EASTLAKE AVE
Second Line	:	SUITE 7416
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-2211
Country	:	US
Telephone Number	:	323-865-3700
Fax Number	:	323-865-0120

Authorized Official
Title or Position	:	PROFESSOR OF CLINICAL UROLOGY
Name	:	DR. OSAMU UKIMURA
Credential	:	M.D.,PH.
Telephone Number	:	323-865-3700

Provider Enumeration Date	:	04/16/2010
Last Update Date	:	04/16/2010

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