MEDICARE: MISS SANISETH UTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1609911122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SANISETH UTH

Provider Business Mailing Address
First Line	:	438 N WHITE RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-1439
Country	:	US
Telephone Number	:	408-254-6828
Fax Number	:	408-254-6838

Provider Business Practice Location Address
First Line	:	438 N WHITE RD
Second Line	:	ALLIANCE FOR COMMUNITY CARE SERVICE TEAM ADULT OUTPATIE
City	:	SAN JOSE
State	:	CA
Zip	:	95127-1439
Country	:	US
Telephone Number	:	408-254-6828
Fax Number	:	408-254-6838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	05/29/2025

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Directions to “ MISS SANISETH UTH ” Practice Location

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