MEDICARE: UC REGENTS UCLA DEPARTMENT OF MEDICINE PROF GROUP

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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1861441602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UC REGENTS UCLA DEPARTMENT OF MEDICINE PROF GROUP

Provider Business Mailing Address
First Line	:	PO BOX 24DD5
Second Line	:	WESTWOOD STATION
City	:	LOS ANGELES
State	:	CA
Zip	:	90024
Country	:	US
Telephone Number	:	310-301-8708
Fax Number	:	310-301-8751

Provider Business Practice Location Address
First Line	:	11303 W WASHINGTON BLVD
Second Line	:	#100
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-6003
Country	:	US
Telephone Number	:	310-391-7281
Fax Number	:

Authorized Official
Title or Position	:	VICE CHAIR OF CLINICAL SERVICES
Name	:	DR. ROBERT K OYE
Credential	:	MD
Telephone Number	:	310-206-0644

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	09/11/2025

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