Provider Demographics
NPI:1104300011
Name:MEKONG COMMUNITY CENTER
Entity type:Organization
Organization Name:MEKONG COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-914-2894
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?:Yes
Parent Organization LBN:NA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherSANTA CLARA VALLEY HEALTH & HOSPITAL SYSTEM