Provider Demographics
NPI:1326440132
Name:PURPLE LOTUS UNIVERSITY
Entity Type:Organization
Organization Name:PURPLE LOTUS UNIVERSITY
Other - Org Name:PURPLE LOTUS UNIVERSITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-429-8808
Mailing Address - Street 1:33615 9TH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-2316
Mailing Address - Country:US
Mailing Address - Phone:510-429-8808
Mailing Address - Fax:510-894-8394
Practice Address - Street 1:33615 9TH ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-2316
Practice Address - Country:US
Practice Address - Phone:510-429-8808
Practice Address - Fax:510-894-8394
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PURPLE LOTUS TEMPLE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 175F00000X
CA16004171100000X, 172P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No172P00000XOther Service ProvidersNaprapathGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty