Healthcare Provider Details

I. General information

NPI: 1952350787
Provider Name (Legal Business Name): UC REGENTS UCLA DEPARTMENT OF MED PROF GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 SANTA MONICA BLVD SUITE 200,404
SANTA MONICA CA
90404-2045
US

IV. Provider business mailing address

PO BOX 24 DD5 WEST WOOD STATION
LOS ANGELES CA
90024
US

V. Phone/Fax

Practice location:
  • Phone: 310-998-5658
  • Fax:
Mailing address:
  • Phone: 310-301-8708
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT OYE
Title or Position: VICE CHAIR OF CLINICAL SERVICES
Credential: MD
Phone: 310-206-0644