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General NPI Number Information
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NPI Number | 1245586452
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Entity Type | Organization
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Legal Business Name | FOREST HILLS HEALTH GROUP
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 579 ESTUDILLO AVE SUITE B
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4653
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Country | US
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Telephone | 510-900-9188
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Fax |
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Provider Business Mailing Address
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Address Line | 579 ESTUDILLO AVE STE B
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City | SAN LEANDRO
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State | CA
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Zip | 94577-4640
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Country | US
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Telephone | 510-900-9188
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JIAZHONG DU
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Credential |
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Telephone | 510-900-9188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 14655
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License Number State | CA
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