Healthcare Provider Details

I. General information

NPI: 1306139126
Provider Name (Legal Business Name): KALUB J JAROSH L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 ELLSWORTH ST
BERKELEY CA
94705
US

IV. Provider business mailing address

4123 #520 BROADWAY AVE
OAKLAND CA
94611
US

V. Phone/Fax

Practice location:
  • Phone: 617-412-7085
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number14234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: