=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801070198
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | USC SCHOOL OF MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2007
-----------------------------------------------------
Last Update Date | 12/21/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1675 AMBERWOOD DR APT 20
-----------------------------------------------------
City | SOUTH PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91030-1958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-646-6807
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1675 AMBERWOOD DR APT 20
-----------------------------------------------------
City | SOUTH PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91030-1958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-646-6807
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. PARA CHANDRASOMA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 323-226-4616
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | A86623
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------