Provider Demographics
NPI:1528195146
Name:HOI QUAN CUU LONG- MEKONG COMMUNITY CENTER
Entity Type:Organization
Organization Name:HOI QUAN CUU LONG- MEKONG COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC. DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:TA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-937-1553
Mailing Address - Street 1:2203 TULLY RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1348
Mailing Address - Country:US
Mailing Address - Phone:408-937-1553
Mailing Address - Fax:
Practice Address - Street 1:2203 TULLY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1348
Practice Address - Country:US
Practice Address - Phone:408-937-1553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1006429251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health