# UNIVERSITY OF CALIFORNIA DAVIS MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376767665
- **Authorized official:** MR. VINCENT SAM FONG ACSW 16761 (PEDIATRIC SOCIAL WORKER)
- **Authorized official phone:** (916) 734-1665

## Contact information

- **Practice address:** 2521 STOCKTON BLVD STE 3110, SACRAMENTO, CA 95817-2207
- **Practice address phone:** (916) 734-1665
- **Practice address fax:** (916) 734-0561
- **Mailing address:** 3304 MONTE VISTA AVE, DAVIS, CA 95618
- **Mailing address phone:** (530) 758-5385
- **Mailing address fax:** (916) 734-0561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 04/11/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | ASW 16761 | CLINICAL SOCIAL WORKER | CA |