Provider Demographics
NPI:1518586700
Name:SBA CLINIC
Entity Type:Organization
Organization Name:SBA CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIU
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:408-962-0854
Mailing Address - Street 1:1210 E ARQUES AVE STE 215
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-5422
Mailing Address - Country:US
Mailing Address - Phone:408-962-0854
Mailing Address - Fax:415-480-6673
Practice Address - Street 1:1210 E ARQUES AVE STE 215
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-5422
Practice Address - Country:US
Practice Address - Phone:408-962-0854
Practice Address - Fax:415-480-6673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-08
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty