Basic Information
| Provider Information | |||||||||
| NPI: | 1316338775 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASIAN AMERICANS FOR COMMUNITY INVOLVEMENT OF SANTA CLARA COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 MOORPARK AVE STE 319 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951282625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089752730 | ||||||||
| FaxNumber: | 4089752745 | ||||||||
| Practice Location | |||||||||
| Address1: | 749 STORY RD STE 50 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951222600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6698006991 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2015 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| AuthorizedOfficialLastName: | KOHLI | ||||||||
| AuthorizedOfficialFirstName: | SARITA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO AND PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4089752730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ASIAN AMERICANS FOR COMMUNITY INVOLVEMENT OF SANTA CLARA COUNTY INC | ||||||||
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| AuthorizedOfficialCredential: | LMFT, MBA | ||||||||
| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.