Healthcare Provider Details

I. General information

NPI: 1992831655
Provider Name (Legal Business Name): REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10833 LE CONTE AVE BOX 951668 RM A0-125CHS
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

10833 LE CONTE AVE BOX 951668 RM A0-125CHS
LOS ANGELES CA
90095-1668
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-8879
  • Fax: 310-794-9723
Mailing address:
  • Phone: 310-825-8879
  • Fax: 310-825-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2075
License Number StateCA

VIII. Authorized Official

Name: DR. FARIBA SIMHAI YOUNAI
Title or Position: DIRECTOR
Credential:
Phone: 310-825-8879