Healthcare Provider Details

I. General information

NPI: 1649467556
Provider Name (Legal Business Name): SOUTH BAY ALLERGY & ASTHMA GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 MOORPARK AV SUITE 130
SAN JOSE CA
95128-2625
US

IV. Provider business mailing address

2211 MOORPARK AV SUITE 130
SAN JOSE CA
95128-2625
US

V. Phone/Fax

Practice location:
  • Phone: 408-286-1744
  • Fax: 408-286-1707
Mailing address:
  • Phone: 408-286-1744
  • Fax: 408-286-1707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberG12038
License Number StateCA

VIII. Authorized Official

Name: ANLIN XU
Title or Position: PRESIDENT
Credential: MD
Phone: 408-286-1707