MEDICARE: IU-MIEN COMMUNITY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	405300000X	Prevention Professional

General Provider Information

NPI Number	:	1245740810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IU-MIEN COMMUNITY SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 245693
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95824-5693
Country	:	US
Telephone Number	:	916-383-3083
Fax Number	:

Provider Business Practice Location Address
First Line	:	5625 STOCKTON BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95824-1611
Country	:	US
Telephone Number	:	916-383-3083
Fax Number	:

Authorized Official
Title or Position	:	EXCUTIVE DIRECTOR
Name	:	MR. KAO C THUN
Credential	:
Telephone Number	:	916-383-3083

Provider Enumeration Date	:	10/09/2017
Last Update Date	:	10/09/2017

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