Provider Demographics
NPI:1033295449
Name:ASIAN NETWORK PHYSICAL THERAPY AND REHABILITATION
Entity type:Organization
Organization Name:ASIAN NETWORK PHYSICAL THERAPY AND REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:IVY
Authorized Official - Middle Name:YIP
Authorized Official - Last Name:KWONG
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,MPA
Authorized Official - Phone:510-268-1118
Mailing Address - Street 1:821 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4422
Mailing Address - Country:US
Mailing Address - Phone:510-268-1118
Mailing Address - Fax:510-268-0111
Practice Address - Street 1:821 HARRISON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4422
Practice Address - Country:US
Practice Address - Phone:510-268-1118
Practice Address - Fax:510-268-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAREH04526FMedicaid
CAREH04526FMedicaid