Healthcare Provider Details

I. General information

NPI: 1912282849
Provider Name (Legal Business Name): THE REGENTS OF THE UNIVERSITY OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 UNIVERSITY AVE
RIVERSIDE CA
92507-4600
US

IV. Provider business mailing address

900 UNIVERSITY AVE
RIVERSIDE CA
92507-4600
US

V. Phone/Fax

Practice location:
  • Phone: 951-827-2731
  • Fax: 951-827-3133
Mailing address:
  • Phone: 951-827-2731
  • Fax: 951-827-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number193200000X
License Number StateCA

VIII. Authorized Official

Name: MR. DANNY KIM
Title or Position: ASSOCIATE VICE CHANCELLOR
Credential:
Phone: 951-827-2731