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CAN050660-05 USC Norris Cancer Hospital (Active)
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Main Details
Name
USC Norris Cancer Hospital
Subdivision Name
Buena Park - Buena Park Infusion
Type
Free Standing Cancer Hospital
Rural
No
340B ID
CAN050660-05
Medicare Provider Number
050660
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2020
Participating Start Date
4/1/2020
Participating Approval Date
1/30/2020
Last Recertification Date
8/22/2024
Contacts
Authorizing Official
Keck Medicine of USC
Rod Hanners, Chief Operating Officer
(323) 442-8677
Primary Contact
Keck Medicine of USC
Krist Azizian, Chief Pharmacy Officer
(323) 865-3588
Addresses
Street Address
5832 Beach Blvd Suite 201
Buena Park, CA 90621
Billing Address
USC Kenneth Norris Jr Cancer Hospital
1441 Eastlake Ave
Room 1355, First Floor
Los Angeles, CA 90033
Comments
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