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General NPI Number Information
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NPI Number | 1255717377
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Entity Type | Organization
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Legal Business Name | UCSD DEPARTMENT OF PEDIATRICS
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Dates
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Enumeration Date | 07/31/2015
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 7910 FORST ST SUITE 100
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City | SAN DIEGO
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State | CA
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Zip | 92123
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Country | US
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Telephone | 858-246-1738
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Fax | 858-246-1793
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Provider Business Mailing Address
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Address Line | 5531 LADYBIRD LN
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City | LA JOLLA
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State | CA
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Zip | 92037-7721
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Country | US
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Telephone | 858-761-1308
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Fax |
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Authorized Official
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Title or Position | DIVISION CHIEF
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Name | PROF. KENNETH LYONS JONES
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Credential | M.D.
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Telephone | 858-246-1738
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | SFP000030
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License Number State | CA
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