Individual provider Active NPI

Tith Chan

  • Clinical Social Worker
  • San Jose, CA
National Provider Identifier
1891975256
Registry record updated Mar 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
75516 Issued in CA
Practice address
160 E Virginia St Ste 280
San Jose, CA 95112-5817
Phone
(408) 287-6200
NPI assigned
Nov 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Social Worker 1041C0700X 75516 CA Primary

Addresses

Primary practice location

160 E Virginia St Ste 280
San Jose, CA 95112-5817

Mailing address

160 E Virginia St Ste 100
San Jose, CA 95112-5865
Phone (408) 287-6200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200206002249 CA Practitioner - Clinical Social Worker 9133555337 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Gardner Family Health Network IncGroup PAC ID 5890859375, 24 clinicians

Practice addresses (Care Compare)

160 E Virginia St
Suite 100
San Jose, CA 95112-5865
Phone (408) 918-2618

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
75516CAMDPharmacist

Practice roles (3 of 4)

OrganizationSpecialtyStatusNew patients
Gardner Family Health Network Inc CurrentSince Dec 9, 2019 Accepting new patients
Gardner Family Health Network, Inc. CurrentSince Dec 9, 2019 Accepting new patients
Najmi Family Therapy Inc Mental Health PastSince Jun 28, 2020 Accepting new patients

Locations

160 E Virginia St
Ste 280
San Jose, CA 95112
Phone (408) 457-7100

160 E Virginia St
Ste 100
San Jose, CA 95112
Phone (408) 918-2618

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677801600000",
    "number": "1891975256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 E VIRGINIA ST STE 100",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951125865",
            "telephone_number": "408-287-6200",
            "fax_number": "408-998-1535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 E VIRGINIA ST STE 280",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951125817",
            "telephone_number": "408-287-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "TITH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-13",
        "last_updated": "2023-03-03",
        "certification_date": "2023-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "75516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Jose, CA

Sources for this page

Verify at the official NPI Registry.