Healthcare Provider Details

I. General information

NPI: 1417968413
Provider Name (Legal Business Name): CITY OF HOPE MEDICAL FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 01/07/2022
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 ELM AVE STE 104
LONG BEACH CA
90813-3271
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 562-590-0345
  • Fax: 562-437-8139
Mailing address:
  • Phone: 626-775-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT JENSEN
Title or Position: CEO
Credential:
Phone: 626-256-4673