Provider Demographics
NPI:1114303286
Name:JOY FORERUNNER ACUPUNCTURE CLINIC INC
Entity Type:Organization
Organization Name:JOY FORERUNNER ACUPUNCTURE CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-598-7253
Mailing Address - Street 1:39150 SUNDALE DR APT 122
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2042
Mailing Address - Country:US
Mailing Address - Phone:408-598-7253
Mailing Address - Fax:
Practice Address - Street 1:39275 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1519
Practice Address - Country:US
Practice Address - Phone:408-598-7253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-30
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC15871171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty