1306105333 NPI number — UCSD MEDICAL CENTER

Table of content: TIFFANY SHIN SU MD (NPI 1962618611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306105333 NPI number — UCSD MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCSD MEDICAL CENTER
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:
THE JOHN M & SALLY B THORNTON HOSPITAL PHARMACY
Provider Other Organization Name Type Code:
3
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:
1306105333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 W ARBOR DR
Provider Second Line Business Mailing Address:
MAIL CODE 8765
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92103-9000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-543-6194
Provider Business Mailing Address Fax Number:
619-543-5829

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9300 CAMPUS POINT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA JOLLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92037-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-657-5891
Provider Business Practice Location Address Fax Number:
858-657-5890
Provider Enumeration Date:
05/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GARY
Authorized Official First Name:
HAGNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR,UCSD AMCARE PHARMACY
Authorized Official Telephone Number:
619-543-6194

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  HPE39291 , 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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