NPIMap

Organization Active NPI

St Jude Hospital Yorba Linda

  • Internal Medicine Physician
  • Fullerton, CA
National Provider Identifier
1700214913
Registry record updated Jan 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ST JUDE HOSPITAL YORBA LINDA
Practice address
2141 N Harbor Blvd
Suite 25000
Fullerton, CA 92835-3827
Phone
(714) 626-8610
Fax
(714) 626-8655
NPI assigned
Oct 25, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Bennett
Title
Chief Operating Officer
Phone
(714) 449-4800

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

2141 N Harbor Blvd
Suite 25000
Fullerton, CA 92835-3827

Mailing address

279 Imperial Hwy
Suite 730
Fullerton, CA 92835-1041
Phone (714) 449-4800

Other identifiers 1

IdentifierTypeStateIssuer
6852510003OtherCANSC

Other names 1

  • ST JOSEPH HERITAGE HEALTHCARE Doing business as

National Provider Directory

National Provider Directory

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1382659200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390262400000",
    "number": "1700214913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "279 IMPERIAL HWY",
            "address_2": "SUITE 730",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928351041",
            "telephone_number": "714-449-4800",
            "fax_number": "714-449-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2141 N HARBOR BLVD",
            "address_2": "SUITE 25000",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353827",
            "telephone_number": "714-626-8610",
            "fax_number": "714-626-8655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE HOSPITAL YORBA LINDA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-25",
        "last_updated": "2014-01-21",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "714-449-4800"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NSC",
            "identifier": "6852510003",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ST JOSEPH HERITAGE HEALTHCARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.