NPIMap

Organization Active NPI

Tubi Connect Inc.

  • Adult Mental Health Clinic/Center
  • La Jolla, CA
National Provider Identifier
1659919140
Registry record updated Dec 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
TUBI CONNECT INC.
Practice address
8950 Villa la Jolla Dr Ste C117
La Jolla, CA 92037-1707
Phone
(858) 997-0235
NPI assigned
Dec 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kim HuynhNPI 1346876505
Title
Administrator
Phone
(858) 997-7415

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Electroneurodiagnostic Specialist/TechnologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 246ZE0600X
Public Health or Welfare Agency 251K00000X
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Adult Mental Health Clinic/Center 261QM0850X Primary
Research Clinic/Center 261QR1100X

Addresses

Primary practice location

8950 Villa la Jolla Dr Ste C117
La Jolla, CA 92037-1707

Mailing address

2434 Meadow Lark Dr
San Diego, CA 92123-3316
Phone (858) 997-7415

Other names 1

  • White Ink Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200501000323 CA Part B Supplier - Clinic/Group Practice 3971933318 Receives reassigned benefits from 4 practitioners
Practice locations: La Jolla, CA

National Provider Directory

National Provider Directory

Locations

2400 Barranca Pkwy
Ste 1801
Irvine, CA 92606
Phone (858) 997-7415

7071 Consolidated Way
San Diego, CA 92121
Phone (619) 452-1200

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703721600000",
    "number": "1659919140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2434 MEADOW LARK DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921233316",
            "telephone_number": "858-997-7415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8950 VILLA LA JOLLA DR STE C117",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371707",
            "telephone_number": "858-997-0235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TUBI CONNECT INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-15",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-21",
        "status": "A",
        "authorized_official_last_name": "HUYNH",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "858-997-7415"
    },
    "taxonomies": [
        {
            "code": "246ZE0600X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Research",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Ink Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Jolla, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.