Healthcare Provider Details

I. General information

NPI: 1770728438
Provider Name (Legal Business Name): UNIVERSITY OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 02/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 EASTLAKE AVE
LOS ANGELES CA
90089-0112
US

IV. Provider business mailing address

1441 EASTLAKE AVENUE
LOS ANGELES CA
90089-0112
US

V. Phone/Fax

Practice location:
  • Phone: 323-865-3000
  • Fax: 323-865-0159
Mailing address:
  • Phone: 323-442-8444
  • Fax: 323-442-5257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number930000267
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. THOMAS E JACKIEWICZ
Title or Position: SVP & CEO, KECK MEDICINE OF USC
Credential:
Phone: 323-442-9775