Provider Demographics
NPI:1164567681
Name:HEN, VISARA
Entity type:Individual
Prefix:MR
First Name:VISARA
Middle Name:
Last Name:HEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5319
Mailing Address - Country:US
Mailing Address - Phone:408-510-3420
Mailing Address - Fax:408-510-3427
Practice Address - Street 1:438 N WHITE RD
Practice Address - Street 2:ALLIANCE FOR COMMUNITY CARE SERVICE TEAM OUTPATIENT
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-1439
Practice Address - Country:US
Practice Address - Phone:408-254-6828
Practice Address - Fax:408-254-6838
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator