Healthcare Provider Details

I. General information

NPI: 1356225676
Provider Name (Legal Business Name): JENNIFER TAI LAC, DACCHM, DIPL.OM
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 ENCINITAS BLVD STE 107
ENCINITAS CA
92024-3744
US

IV. Provider business mailing address

5663 BALBOA AVE # 2
SAN DIEGO CA
92111-2705
US

V. Phone/Fax

Practice location:
  • Phone: 619-964-7660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC20329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: