Provider Demographics
NPI:1821501792
Name:ASIAN HEALTH SERVICES
Entity Type:Organization
Organization Name:ASIAN HEALTH SERVICES
Other - Org Name:THE HARRY & JEANETTE WEINBERG DENTAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OF OPERATION OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DONG
Authorized Official - Middle Name:W
Authorized Official - Last Name:SUH
Authorized Official - Suffix:
Authorized Official - Credentials:COO
Authorized Official - Phone:510-735-3110
Mailing Address - Street 1:101 8TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4707
Mailing Address - Country:US
Mailing Address - Phone:510-735-3110
Mailing Address - Fax:510-986-6885
Practice Address - Street 1:190 11TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4878
Practice Address - Country:US
Practice Address - Phone:510-250-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASIAN HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-14
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000666261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447391719Medicaid
CA1821501792Medicaid