Provider Demographics
NPI:1376961664
Name:ASIAN COMMUNITY MENTAL HEALTH BOARD
Entity Type:Organization
Organization Name:ASIAN COMMUNITY MENTAL HEALTH BOARD
Other - Org Name:ASIAN COMMUNITY MENTAL HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-794-7888
Mailing Address - Street 1:310 - 8TH STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6527
Mailing Address - Country:US
Mailing Address - Phone:510-869-6000
Mailing Address - Fax:510-839-4723
Practice Address - Street 1:13847 E 14TH ST
Practice Address - Street 2:SUITE 116
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2632
Practice Address - Country:US
Practice Address - Phone:510-869-6000
Practice Address - Fax:510-839-4723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASIAN COMMUNITY MENTAL HEALTH BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-04-03
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ24335ZMedicare UPIN