San Jose Community Clinic

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

A055334 Issued in CA

Legal business name

SAN JOSE COMMUNITY CLINIC

Practice address

11950 Inglewood Ave
Hawthorne, CA 90250

Phone

(310) 349-8338

Fax

(310) 349-8340

NPI assigned

Mar 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Reza Danesh, MDNPI 1649376229

Title

Ceo

Phone

(310) 349-8338

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Reza Danesh, MD

  • General Practice Physician
  • Los Alamitos, CA
  • NPI 1649376229
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529280000000",
    "number": "1285751024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 903",
            "city": "PALOS VERDES ESTATES",
            "state": "CA",
            "postal_code": "902740903",
            "telephone_number": "310-349-8338",
            "fax_number": "310-349-8340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11950 INGLEWOOD AVE",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "90250",
            "telephone_number": "310-349-8338",
            "fax_number": "310-349-8340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN JOSE COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-25",
        "last_updated": "2018-06-18",
        "status": "A",
        "authorized_official_last_name": "DANESH",
        "authorized_official_first_name": "REZA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-349-8338",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A055334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A553341",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mervat R Salama, D.D.S.
• S George Salama, DDS
• Azadeh Salami, MD
• Rhea Saligumba
• Brianna Salinas, COTA/L
• Maria D Sanchez
• Martin Sanchez
• Raymond Anthony Sanchez Jr.
• Sandhurst Convalescent Group, LTD.
• Santa Maria Dental Office Inc

• Clinic/Center in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.