Healthcare Provider Details

I. General information

NPI: 1366620189
Provider Name (Legal Business Name): INTERNATIONAL COMMUNITY HEALTHCARE RESOURCE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 CALIFORNIA CIR #100
MILPITAS CA
95035-8101
US

IV. Provider business mailing address

1533 CALIFORNIA CIR #100
MILPITAS CA
95035-8101
US

V. Phone/Fax

Practice location:
  • Phone: 408-719-1004
  • Fax: 408-719-1094
Mailing address:
  • Phone: 408-719-1004
  • Fax: 408-719-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TAE KYUNG KIM
Title or Position: ADMINISTRATOR
Credential: D.C.
Phone: 408-719-1004