=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629421490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UC DAVIS MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2016
-----------------------------------------------------
Last Update Date | 07/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4150 V ST STE 1200
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95817-1460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-734-5031
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4150 V ST STE 1200
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95817-1460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | RESIDENCY DIRECTOR
-----------------------------------------------------
Name | DR. AMRIK SINGH
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 916-734-5031
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 136638
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------