Provider Demographics
NPI:1548349830
Name:REGENTS OF THE UNIV OF CA
Entity type:Organization
Organization Name:REGENTS OF THE UNIV OF CA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-734-1166
Mailing Address - Street 1:4900 BROADWAY
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820
Mailing Address - Country:US
Mailing Address - Phone:916-734-9200
Mailing Address - Fax:916-734-9661
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-9331
Practice Address - Fax:916-734-9661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE7275OtherRAILROAD MEDICARE PIN
CACR0028OtherRAILROAD MEDICARE PIN
CACN4844OtherRAILROAD MEDICARE PIN
CADA4168OtherRAILROAD MEDICARE PIN
CACI4127OtherRAILROAD MEDICARE PIN
CAZZZP5702ZMedicaid
CACN4400OtherRAILROAD MEDICARE PIN
CACI4127OtherRAILROAD MEDICARE PIN