Provider Demographics
NPI:1740699768
Name:ASIAN COMMUNITY MENTAL HEALTH BOARD
Entity type:Organization
Organization Name:ASIAN COMMUNITY MENTAL HEALTH BOARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 ST
Mailing Address - Street 2:201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6526
Mailing Address - Country:US
Mailing Address - Phone:510-869-6000
Mailing Address - Fax:510-839-4723
Practice Address - Street 1:12240 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2453
Practice Address - Country:US
Practice Address - Phone:510-970-9750
Practice Address - Fax:510-970-9751
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASIAN COMMUITY MENTAL HEALTH BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24335ZMedicare UPIN