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General NPI Number Information
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NPI Number | 1679638837
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Entity Type | Organization
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Legal Business Name | EASTFIELD MING QUONG
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3411 ROCKY MOUNTAIN DR
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City | SAN JOSE
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State | CA
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Zip | 95127-4853
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Country | US
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Telephone | 408-379-3790
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Fax |
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Provider Business Mailing Address
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Address Line | 251 LLEWELLYN AVE
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City | CAMPBELL
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State | CA
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Zip | 95008-1940
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Country | US
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Telephone | 408-379-3790
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Fax |
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Authorized Official
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Title or Position | DIVISION DIRECTOR
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Name | LAURA CHAMPION
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Credential | LMFT
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Telephone | 408-379-3790
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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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