Provider Demographics
NPI:1548318199
Name:HOI-QUAN CUU LONG MEKONG COMMUNITY CENTER INC
Entity type:Organization
Organization Name:HOI-QUAN CUU LONG MEKONG COMMUNITY CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LONG
Authorized Official - Middle Name:THIEN
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:408-914-2880
Mailing Address - Street 1:2670 S WHITE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2073
Mailing Address - Country:US
Mailing Address - Phone:408-937-1553
Mailing Address - Fax:408-937-1548
Practice Address - Street 1:2670 S WHITE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2073
Practice Address - Country:US
Practice Address - Phone:408-937-1553
Practice Address - Fax:408-937-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01047100251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health