Healthcare Provider Details

I. General information

NPI: 1750988770
Provider Name (Legal Business Name): KECK MEDICAL CENTER OF USC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SAN PABLO ST
LOS ANGELES CA
90033-5313
US

IV. Provider business mailing address

1500 SAN PABLO ST
LOS ANGELES CA
90033-5313
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-8444
  • Fax:
Mailing address:
  • Phone: 323-422-8677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: JEANNINE TAYLOR
Title or Position: SECRETARY
Credential:
Phone: 213-740-7922