Provider Demographics
NPI:1215076419
Name:ASIAN PACIFIC ISLANDER
Entity type:Organization
Organization Name:ASIAN PACIFIC ISLANDER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR, DBH
Authorized Official - Prefix:
Authorized Official - First Name:DAWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:UTECHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-600-6895
Mailing Address - Street 1:5108 E CLINTON WAY STE 108
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-2043
Mailing Address - Country:US
Mailing Address - Phone:559-452-3463
Mailing Address - Fax:
Practice Address - Street 1:4445 E INYO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-2977
Practice Address - Country:US
Practice Address - Phone:559-253-9131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000001084261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2185OtherCOST CENTER
CA000001084Medicaid
CAZZZ82027ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER