Provider Demographics
NPI:1457798019
Name:SLEEP CLINIC OF NORTHERN CALIFORNIA
Entity Type:Organization
Organization Name:SLEEP CLINIC OF NORTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRI
Authorized Official - Middle Name:ANH
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:408-535-6900
Mailing Address - Street 1:999 STORY ROAD
Mailing Address - Street 2:SUITE 9021
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-4604
Mailing Address - Country:US
Mailing Address - Phone:408-535-6900
Mailing Address - Fax:408-535-6901
Practice Address - Street 1:999 STORY ROAD
Practice Address - Street 2:SUITE 9021
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-4604
Practice Address - Country:US
Practice Address - Phone:408-535-6900
Practice Address - Fax:408-535-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23869291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457798019Medicaid