Provider Demographics
NPI:1275004244
Name:STANFORD EMPLOYER HEALTH CLINICS
Entity Type:Organization
Organization Name:STANFORD EMPLOYER HEALTH CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:YAU-TUNG
Authorized Official - Last Name:KWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-450-0624
Mailing Address - Street 1:1189 COLEMAN AVE
Mailing Address - Street 2:2ND FLOOR SUITE E2-100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1189 COLEMAN AVE
Practice Address - Street 2:2ND FLOOR SUITE E2-100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110
Practice Address - Country:US
Practice Address - Phone:925-785-7377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care