Provider Demographics
NPI:1750483616
Name:UNIVERSITY HEAD AND NECK ASSOCIATES
Entity type:Organization
Organization Name:UNIVERSITY HEAD AND NECK ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROF CHIEF HEAD AND NECK UCLA
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BERKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-825-5179
Mailing Address - Street 1:PO BOX 512025
Mailing Address - Street 2:DEPT A20
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051
Mailing Address - Country:US
Mailing Address - Phone:310-206-6688
Mailing Address - Fax:310-206-1393
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:550
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-206-6688
Practice Address - Fax:310-206-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49086YMedicaid
CAHW3281Medicare PIN