Healthcare Provider Details

I. General information

NPI: 1871401679
Provider Name (Legal Business Name): DAVID BOM LE ASW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 43RD ST # 1034
OAKLAND CA
94609-2138
US

IV. Provider business mailing address

490 43RD ST # 1034
OAKLAND CA
94609-2138
US

V. Phone/Fax

Practice location:
  • Phone: 925-532-7665
  • Fax: 510-373-2139
Mailing address:
  • Phone: 925-532-7665
  • Fax: 510-373-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW141103
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: