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General NPI Number Information
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NPI Number | 1083895569
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF CALIFORNIA IRVINE STUDENT HEALTH CENTER
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 11/26/2007
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Provider Practice Location Address
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Address Line | UNIVERSITY OF CALIFORNIA IRVINE STUDENT HEALTH CENTER 501 STUDENT HEALTH
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City | IRVINE
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State | CA
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Zip | 92697-5200
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Country | US
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Telephone | 949-824-1835
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Fax |
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Provider Business Mailing Address
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Address Line | UNIVERSITY OF CALIFORNIA IRVINE STUDENT HEALTH CENTER 501 STUDENT HEALTH
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City | IRVINE
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State | CA
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Zip | 92697-5200
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Country | US
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Telephone | 949-824-1835
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Fax |
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Authorized Official
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Title or Position | CHIEF, MENTAL HEALTH SERVICE
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Name | DR. VIVIEN CHAN
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Credential | M.D.
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Telephone | 949-824-1835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | PSY 20900
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License Number State | CA
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