| Mekong Community Center | |
|
2670 S White Rd Ste 200 San Jose CA 95148-2073 | |
| (408) 937-1553 | |
| (408) 937-1548 |
| Full Name | Mekong Community Center |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 2670 S White Rd Ste 200, San Jose, California |
| Authorized Official Name and Position | Long Thien Vu (CEO) |
| Authorized Official Contact | 4089142880 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mekong Community Center 2670 S White Rd Ste 200 San Jose CA 95148-2073 Ph: (408) 937-1553 | Mekong Community Center 2670 S White Rd Ste 200 San Jose CA 95148-2073 Ph: (408) 937-1553 |
| NPI Number | 1548318199 |
|---|---|
| Provider Enumeration Date | 01/08/2007 |
| Last Update Date | 07/22/2022 |
| Certification Date | 07/22/2022 |
| Medicare PECOS PAC ID | 1658305313 |
|---|---|
| Medicare Enrollment ID | O20050921001160 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548318199 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 01047100 (California) | Primary |
| Provider Name | Cuong T Nguyen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1609903400 PECOS PAC ID: 3779551536 Enrollment ID: I20041101000594 |
| Provider Name | Long Thien Vu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1811267016 PECOS PAC ID: 4587066493 Enrollment ID: I20210804003712 |
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