Provider Demographics
NPI:1245586452
Name:FOREST HILLS HEALTH GROUP
Entity Type:Organization
Organization Name:FOREST HILLS HEALTH GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JIAZHONG
Authorized Official - Middle Name:
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-900-9188
Mailing Address - Street 1:579 ESTUDILLO AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4640
Mailing Address - Country:US
Mailing Address - Phone:510-900-9188
Mailing Address - Fax:
Practice Address - Street 1:579 ESTUDILLO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4653
Practice Address - Country:US
Practice Address - Phone:510-900-9188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 14655171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty