Basic Information
Provider Information
NPI: 1740659374
EntityType: 2
ReplacementNPI:  
OrganizationName: COMMUNITY HEALTH FOR ASIAN AMERICANS
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: RICHMOND HIGH SCHOOL
OtherOrganizationType: 5
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1141 HARBOR BAY PARKWAY
Address2: #105
City: ALAMEDA
State: CA
PostalCode: 945024724
CountryCode: US
TelephoneNumber: 5108352777
FaxNumber: 5108350164
Practice Location
Address1: 1250 23RD ST
Address2:  
City: RICHMOND
State: CA
PostalCode: 948041011
CountryCode: US
TelephoneNumber: 5102378770
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/24/2015
LastUpdateDate: 09/19/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: YU
AuthorizedOfficialFirstName: CHEN
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: DIRECTOR OF FINANCE
AuthorizedOfficialTelephone: 5108352777
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251S00000X  Y AgenciesCommunity/Behavioral Health 

No ID Information.


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