Healthcare Provider Details

I. General information

NPI: 1790945467
Provider Name (Legal Business Name): UNIVERISTY OF CALIFORNIA SAN DIEGO MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR UCSD MEDICAL CENTER
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

9500 GILMAN DR UCSD MC0726
LA JOLLA CA
92093-5004
US

V. Phone/Fax

Practice location:
  • Phone: 888-309-8273
  • Fax: 619-543-3183
Mailing address:
  • Phone: 858-822-6583
  • Fax: 858-822-6444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA101688
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberA101688
License Number StateCA

VIII. Authorized Official

Name: DR. WILLIAM YAN GO
Title or Position: PHYSICIAN
Credential: M.D., PH.D.
Phone: 858-822-6583