=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619666708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBIN SREJON AHMED CHOUDHURY
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2023
-----------------------------------------------------
Last Update Date | 08/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 THE ALAMEDA
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95126-1136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-207-0565
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1922 THE ALAMEDA STE 3161922
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95126-1457
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-261-7777
-----------------------------------------------------
Fax | 408-642-6052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 124159
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------