Healthcare Provider Details

I. General information

NPI: 1205465747
Provider Name (Legal Business Name): HEALING GROVE HEALTH CENTER INC., A SOCIAL PURPOSE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 W ALMA AVE STE 10
SAN JOSE CA
95110-3520
US

IV. Provider business mailing address

448 GOODYEAR ST
SAN JOSE CA
95110-3201
US

V. Phone/Fax

Practice location:
  • Phone: 408-583-6338
  • Fax: 408-516-1154
Mailing address:
  • Phone: 408-583-6338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHERYL JUNE HO THIEU
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 408-398-6318