Healthcare Provider Details

I. General information

NPI: 1275075780
Provider Name (Legal Business Name): JILL OKUHAMA DAOM, DIPL OM, L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 11/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 87TH ST STE 4
DALY CITY CA
94015-1696
US

IV. Provider business mailing address

PO BOX 6162
SANTA CLARA CA
95056-6162
US

V. Phone/Fax

Practice location:
  • Phone: 650-757-7777
  • Fax:
Mailing address:
  • Phone: 818-810-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number16925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: