1033324462 NPI number — LOMA LINDA UNIVERSITY CHILDREN'S HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033324462 NPI number — LOMA LINDA UNIVERSITY CHILDREN'S HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOMA LINDA UNIVERSITY CHILDREN'S HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033324462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25959 REDLANDS BLVD
Provider Second Line Business Mailing Address:
APT. A
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92373-8475
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-799-8941
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11234 ANDERSON ST
Provider Second Line Business Practice Location Address:
LLUMC HOUSE STAFF OFFICE CP 21005
Provider Business Practice Location Address City Name:
LOMA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92354-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-558-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
SUNHWA
Authorized Official Middle Name:
JENNY
Authorized Official Title or Position:
NEONATOLOGY FELLOW
Authorized Official Telephone Number:
909-558-7448

Provider Taxonomy Codes

  • Taxonomy code: 2080N0001X , with the licence number:  A86164 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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