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General NPI Number Information
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NPI Number | 1639555170
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Entity Type | Organization
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Legal Business Name | WESTERN UNIVERSITY OF HEALTH SCIENCES
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Dates
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Enumeration Date | 08/06/2015
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Last Update Date | 08/06/2015
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Provider Practice Location Address
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Address Line | 200 MULLINS DR
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City | LEBANON
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State | OR
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Zip | 97355-3983
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Country | US
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Telephone | 541-259-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 795 E 2ND ST SUITE 5
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City | POMONA
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State | CA
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Zip | 91766-2007
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Country | US
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Telephone | 909-865-2565
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Fax | 909-865-2955
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Authorized Official
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Title or Position | CFO/TREASURER
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Name | MR. KEVIN SHAW
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Credential |
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Telephone | 909-469-5401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 38807996
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License Number State | OR
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