Provider Demographics
NPI:1740002633
Name:MICRONESIAN ISLANDER COMMUNITY
Entity type:Organization
Organization Name:MICRONESIAN ISLANDER COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MS
Authorized Official - Phone:971-209-5827
Mailing Address - Street 1:PO BOX 18606
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-8606
Mailing Address - Country:US
Mailing Address - Phone:971-209-5827
Mailing Address - Fax:
Practice Address - Street 1:2744 12TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3159
Practice Address - Country:US
Practice Address - Phone:971-209-5827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable