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General NPI Number Information
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NPI Number | 1245740810
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Entity Type | Organization
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Legal Business Name | IU-MIEN COMMUNITY SERVICES
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 5625 STOCKTON BLVD
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City | SACRAMENTO
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State | CA
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Zip | 95824-1611
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Country | US
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Telephone | 916-383-3083
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 245693
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City | SACRAMENTO
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State | CA
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Zip | 95824-5693
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Country | US
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Telephone | 916-383-3083
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Fax |
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Authorized Official
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Title or Position | EXCUTIVE DIRECTOR
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Name | MR. KAO C THUN
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Credential |
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Telephone | 916-383-3083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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