Provider Demographics
NPI:1659919140
Name:TUBI CONNECT INC.
Entity Type:Organization
Organization Name:TUBI CONNECT INC.
Other - Org Name:WHITE INK CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-997-7415
Mailing Address - Street 1:2434 MEADOW LARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3316
Mailing Address - Country:US
Mailing Address - Phone:858-997-7415
Mailing Address - Fax:
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE C117
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1707
Practice Address - Country:US
Practice Address - Phone:858-997-0235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-15
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Single Specialty
No251K00000XAgenciesPublic Health or WelfareGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch