1346298528 NPI number — UC REGENTS

Table of content: DR. KYLE STUART BRUUN MD (NPI 1013775469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346298528 NPI number — UC REGENTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UC REGENTS
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:
6
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:
1346298528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31001-2482
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91110-2482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-456-8026
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 THE CITY DR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-456-8068
Provider Business Practice Location Address Fax Number:
714-456-2979
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COPEN
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER ENROLLMENT MANAGER
Authorized Official Telephone Number:
714-456-6227

Provider Taxonomy Codes

  • Taxonomy code: 335V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: ZZZ22566Z . This is a "BLUE SHIELD GROUP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CD6546 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0077110 . This is a "MEDI-CAL GROUP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: HW13931 . This is a "MEDICARE GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: ZZZP3012Z . This is a "BLUE SHIELD GROUP #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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