Healthcare Provider Details

I. General information

NPI: 1033024054
Provider Name (Legal Business Name): OKSANA CHAZOV ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GLENDALE LN
SACRAMENTO CA
95825-2431
US

IV. Provider business mailing address

PO BOX 245083
SACRAMENTO CA
95824-5083
US

V. Phone/Fax

Practice location:
  • Phone: 916-454-2345
  • Fax:
Mailing address:
  • Phone: 916-454-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW140411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: