1700069051 NPI number — UCLA SCHOOL OF DENTISRTY

Table of content: (NPI 1700069051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700069051 NPI number — UCLA SCHOOL OF DENTISRTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UCLA SCHOOL OF DENTISRTY
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:
SECTION OF ORTHODONTICS
Provider Other Organization Name Type Code:
5
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:
1700069051
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10833 LE CONTE AVE
Provider Second Line Business Mailing Address:
CHS 20-140
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90095-3075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-825-5161
Provider Business Mailing Address Fax Number:
310-206-5349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10833 LE CONTE AVE
Provider Second Line Business Practice Location Address:
CHS 20-140
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90095-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-825-5161
Provider Business Practice Location Address Fax Number:
310-206-5349
Provider Enumeration Date:
12/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KTING
Authorized Official First Name:
KANG
Authorized Official Middle Name:
Authorized Official Title or Position:
CHAIR OF ORTHODONTICS
Authorized Official Telephone Number:
310-825-5161

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  D51398 , 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)

  • Identifier: G0100502 . This is a "MEDI CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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