Provider Demographics
NPI:1649494931
Name:EASTFIELD MING QUONG
Entity type:Organization
Organization Name:EASTFIELD MING QUONG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TORRAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERL
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:909-781-8974
Mailing Address - Street 1:3425 FIELDCREST CT
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-7363
Mailing Address - Country:US
Mailing Address - Phone:909-781-8974
Mailing Address - Fax:
Practice Address - Street 1:572 N ARROWHEAD AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1251
Practice Address - Country:US
Practice Address - Phone:909-266-2710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health