MEDICARE: MR. JASON MICHAEL STARR LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC 10812	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AC10812	OTHER	CA	ACUPUNCTURIST

General Provider Information

NPI Number	:	1760514707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON MICHAEL STARR LAC

Provider Business Mailing Address
First Line	:	1904 PACIFIC AVE
Second Line	:
City	:	VENICE
State	:	CA
Zip	:	90291-4189
Country	:	US
Telephone Number	:	310-666-8366
Fax Number	:

Provider Business Practice Location Address
First Line	:	6221 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5201
Country	:	US
Telephone Number	:	323-549-0070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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