=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457798019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SLEEP CLINIC OF NORTHERN CALIFORNIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2013
-----------------------------------------------------
Last Update Date | 12/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 999 STORY ROAD SUITE 9021
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95122-4604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-535-6900
-----------------------------------------------------
Fax | 408-535-6901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 999 STORY ROAD SUITE 9021
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95122-4604
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-535-6900
-----------------------------------------------------
Fax | 408-535-6901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | TRI ANH DUONG
-----------------------------------------------------
Credential | RRT
-----------------------------------------------------
Telephone | 408-535-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 23869
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------