Provider Demographics
NPI:1386120038
Name:VIETNAMESE VOLUNTARY FOUNDATION, INC.
Entity type:Organization
Organization Name:VIETNAMESE VOLUNTARY FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BRANCH DIRECTOR/ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:THAM
Authorized Official - Middle Name:BICH
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-518-5267
Mailing Address - Street 1:4410 N. PERSHING AVE. C1
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-518-5267
Mailing Address - Fax:
Practice Address - Street 1:4410 N. PERSHING AVE. C1
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-323-5338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEIN=========Medicaid