Provider Demographics
NPI:1023390127
Name:TALLAKSON, SUNHA JOHANNA
Entity Type:Individual
Prefix:
First Name:SUNHA
Middle Name:JOHANNA
Last Name:TALLAKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 RANCHO ARROYO PKWY
Mailing Address - Street 2:#321
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-2756
Mailing Address - Country:US
Mailing Address - Phone:510-856-7251
Mailing Address - Fax:
Practice Address - Street 1:210 N 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5569
Practice Address - Country:US
Practice Address - Phone:510-856-7251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health