Healthcare Provider Details

I. General information

NPI: 1952428443
Provider Name (Legal Business Name): PACIFIC RIM REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N 13TH ST SUITE A
SAN JOSE CA
95112-3528
US

IV. Provider business mailing address

PO BOX 4626
MOUNTAIN VIEW CA
94040-0626
US

V. Phone/Fax

Practice location:
  • Phone: 408-436-5522
  • Fax: 408-436-8777
Mailing address:
  • Phone: 408-436-5522
  • Fax: 408-436-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7085
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22207
License Number StateCA

VIII. Authorized Official

Name: DR. JINJIAN CHEN
Title or Position: OWNER
Credential:
Phone: 408-436-5522