1336409085 NPI number — TKB SPORTS MEDICINE & REHABILITATION

Table of content: (NPI 1336409085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336409085 NPI number — TKB SPORTS MEDICINE & REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TKB SPORTS MEDICINE & REHABILITATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336409085
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10521 POTTS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95111-3330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-440-2359
Provider Business Mailing Address Fax Number:
408-890-4775

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
356 DIGITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MORGAN HILL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95037-2879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-440-2359
Provider Business Practice Location Address Fax Number:
408-890-4775
Provider Enumeration Date:
05/29/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
JENNAH
Authorized Official Middle Name:
HUONG
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
408-440-2359

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225200000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2255A2300X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)