Healthcare Provider Details

I. General information

NPI: 1518586700
Provider Name (Legal Business Name): SBA CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 E ARQUES AVE STE 215
SUNNYVALE CA
94085-5422
US

IV. Provider business mailing address

1210 E ARQUES AVE STE 215
SUNNYVALE CA
94085-5422
US

V. Phone/Fax

Practice location:
  • Phone: 408-962-0854
  • Fax: 415-480-6673
Mailing address:
  • Phone: 408-962-0854
  • Fax: 415-480-6673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: LISA CHIU
Title or Position: PRESIDENT
Credential: LAC
Phone: 408-962-0854