Provider Demographics
NPI:1649467556
Name:SOUTH BAY ALLERGY & ASTHMA GROUP INC
Entity type:Organization
Organization Name:SOUTH BAY ALLERGY & ASTHMA GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-286-1707
Mailing Address - Street 1:2211 MOORPARK AV
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2625
Mailing Address - Country:US
Mailing Address - Phone:408-286-1744
Mailing Address - Fax:408-286-1707
Practice Address - Street 1:2211 MOORPARK AV
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2625
Practice Address - Country:US
Practice Address - Phone:408-286-1744
Practice Address - Fax:408-286-1707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12038207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ14990ZMedicare UPIN