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General NPI Number Information
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NPI Number | 1609341817
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Entity Type | Organization
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Legal Business Name | KOREAN COMMUNITY CENTER OF THE EAST BAY
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Dates
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Enumeration Date | 10/04/2018
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Last Update Date | 10/04/2018
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Provider Practice Location Address
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Address Line | 101 CALLAN AVE STE 400
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4523
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Country | US
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Telephone | 510-547-2662
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Fax |
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Provider Business Mailing Address
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Address Line | 101 CALLAN AVE STE 400
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4523
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Country | US
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Telephone | 510-547-2662
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | YUNJU LEE
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Credential |
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Telephone | 925-789-0922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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