Healthcare Provider Details

I. General information

NPI: 1255790358
Provider Name (Legal Business Name): FAMILY HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4986 CHERRY AVE
SAN JOSE CA
95118
US

IV. Provider business mailing address

4986 CHERRY AVE
SAN JOSE CA
95118
US

V. Phone/Fax

Practice location:
  • Phone: 408-978-6712
  • Fax: 408-265-9965
Mailing address:
  • Phone: 408-978-6712
  • Fax: 408-265-9965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA79732
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberA79732
License Number StateCA

VIII. Authorized Official

Name: DR. RONALD AJLUNI
Title or Position: DOCTOR/OWNER
Credential: D.C.
Phone: 408-978-6712