Provider Demographics
NPI:1518393420
Name:FORTUNE LEAVES CO
Entity Type:Organization
Organization Name:FORTUNE LEAVES CO
Other - Org Name:REN EN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ACUPUNCTURE DOCTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HONGLI
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-306-5988
Mailing Address - Street 1:1590 OAKLAND RD STE B101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-2444
Mailing Address - Country:US
Mailing Address - Phone:408-306-1252
Mailing Address - Fax:408-904-5056
Practice Address - Street 1:1590 OAKLAND RD B101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131
Practice Address - Country:US
Practice Address - Phone:408-306-1252
Practice Address - Fax:408-904-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171100000XOther171100000X